Speaker’s Statement

Mr Speaker: I wish to make a statement concerning the Clerk and Chief Executive of the House. Currently, these two roles are combined in a single post, despite their very different nature. Over the years, Parliament’s affairs have become more complex, its budget has ordinarily risen and decisions—such as on a potential refurbishment of the House—have become unavoidable. Thus, highly skilled management is now vital, as much as expertise in procedure. Yet my preference for separating the two aspects of the post did not meet with sufficient support before the recruitment process started and, in consequence, the combined position of Clerk and Chief Executive was openly advertised.
	A range of candidates was considered by an interview panel consisting of five hon. Members and a lay member, Dame Julie Mellor. Two rounds of interviews were conducted and at each stage the panel sought to select one person who could meet the demanding twin roles both of procedural adviser to the House and of its Chief Executive Officer.
	The panel reached its decision on 30 July. However, a number of colleagues have since expressed disquiet. Their concerns fall into two broad categories. The first, helpfully raised by the right hon. Member for Rutland and Melton (Sir Alan Duncan), is whether the panel should have recommended separating the roles. I was advised that the panel could not adopt this approach without prior legislation. As I have said, there is a compelling case for such a separation, but any change would, of course, require the support of the House.
	The second concern is for pre-appointment scrutiny, and was initially put forward by the hon. Member for North East Somerset (Jacob Rees-Mogg). A strong case can be made for it and, on this point also, I wish to hear colleagues’ views.
	In the circumstances, and having discussed the matter with the Leader and shadow Leader of the House, I believe that a modest pause in the recruitment process is desirable while such issues are explored and the views of Members solicited in detail.
	In the meantime, the functions of the Clerk and Chief Executive will be distributed among members of the Management Board. I am sure that the whole House will wish them well in the discharge of these important duties, while the matter is resolved with good will and by consensus.

ORAL ANSWERS TO QUESTIONS

WORK AND PENSIONS

The Secretary of State was asked—

Benefit Assessment (Charges)

Andrew Griffiths: What assessment he has made of the level of charges levied by doctors for completing benefit assessment information.

Mark Harper: The Department is able to request medical information from doctors as part of the process of assessing an individual’s entitlement to benefit; for example, doctors have to complete the fit note and the ESA113 forms and they have also to complete, where we pay them, forms related to the application for the personal independence payment.

Andrew Griffiths: I thank the Minister for that answer, but East Staffordshire citizens advice bureau has raised with me concerns that GPs are charging vulnerable constituents of mine up to £135 to provide information requested as part of the work capability assessment. Although his Department is not responsible for those charges, does he share my concern that vulnerable people on benefits are being charged this amount of money and may actually not be able to access benefits to which they are entitled?

Mark Harper: I am grateful to my hon. Friend for raising that point. Certainly as far as the WCA for the employment and support allowance is concerned, GPs are contractually required to provide a fit note and to provide the ESA113 form, so perhaps if he and I speak afterwards I can get further details of the specific case he mentions, because it may raise some issues that need to be drawn to my attention.

Frank Field: Might the Minister extend that invitation to other Members of the House who are equally concerned about the charges made on our poorer constituents so that they can make benefits appeals? I am talking about ESA. Can he justify a group who are among the top 1% of salary earners in this country charging our constituents these extraordinary rates, in order that our constituents may try to establish their right, for example, to ESA?

Mark Harper: As I said in answer to my hon. Friend the Member for Burton (Andrew Griffiths), when people are applying for ESA in the first place the Department obviously asks them to provide any medical information they think will be helpful, and as part of that process GPs are required contractually to fill in a specific form. Constituents should not be charged for extra information provided on top of that as part of their application. If the right hon. Gentleman wants to give me the information, I will be very happy to look into the specific case he mentions.

Paul Maynard: Does the Minister share my concern that one major reason for inappropriate decisions is a complete lack of evidence submitted by general practitioners and hospital doctors, without whom no appropriate decision can be made? What views does he have on trying to encourage hospital doctors also to provide this information, to allow the right decision to be made first time around?

Mark Harper: Again, the rules are very clear: under a long-standing agreement, NHS hospitals and trusts are obliged to provide the relevant information free of charge and within 10 working days. However, from listening to my hon. Friend’s question it sounds as if he may have encountered at least one case where that has not happened. I will speak to him afterwards to see whether that raises any issues about whether this policy, which is clear, is actually being implemented by NHS organisations.

Kerry McCarthy: When people in my office were chasing up Atos the other day, they were told that it is still dealing with ESA claims from the beginning of 2013, and that one reason for not being able to process claims more quickly was a difficulty in
	recruiting doctors to submit the medical information. Will the Minister examine this situation urgently, because it is obviously causing huge distress to people who are having to wait well over a year for their claims to be looked at?

Mark Harper: I am not quite sure whether when the hon. Lady talks about Atos she is referring to the work capability assessment—

Kerry McCarthy: indicated assent.

Mark Harper: She nods to say that she is. We have made inroads into the backlog of claims, and it is worth remembering that ESA claimants will normally be in receipt of benefit while they are waiting for the work capability assessment to be looked at.

Pensions (Auto-enrolment)

David Mowat: What steps he is taking to ensure that employees will not be auto-enrolled into high-cost pension schemes.

Steve Webb: As part of our strategy to ensure value for money in pension savings, we announced earlier this year that we would protect members of pension schemes used for automatic enrolment by introducing a default fund cap of 0.75% from April 2015. We will shortly publish more details on the implementation of the charges measures.

David Mowat: I thank the Pensions Minister for that answer, and I congratulate him on introducing that cap, which is half the level of the one introduced by the previous Government for stakeholder pensions. Over time, our cap will save pensioners £1 billion a year. Can he confirm, for the avoidance of doubt, that the cap will also apply to older, legacy pension schemes, some of which currently charge up to 2% per annum?

Steve Webb: I am grateful to my hon. Friend for his supportive comments. Focusing on automatic enrolment, I am pleased to tell him that we aim to protect as many members of automatic enrolment qualifying schemes as possible, regardless of when they started contributing. From April 2015, the cap will therefore apply both to members of schemes newly set up for automatic enrolment and existing qualifying schemes for auto-enrolment.

Barry Gardiner: How concerned is the Minister about savers who want to take advantage of new pension flexibilities being subject to huge penalties in exiting their scheme? What action is he taking to ensure that that cannot happen?

Steve Webb: The hon. Gentleman raises an important point. A review of legacy pension schemes is under way, under the auspices of the Association of British Insurers, and the issue of excessive exit fees is part of it. In most cases, the terms of schemes will allow people to access their budget flexibilities, but there may be some where the contract and scheme rules impose a charge, and that is a contract that people have entered into.

Anne McIntosh: Locally, auto-enrolment seems to be working smoothly for those on monthly salaries, but it is incredibly difficult for those on weekly wages. Are the Government familiar with that? Is the Minister able to assist in that regard?

Steve Webb: We have made a number of changes to make sure that auto-enrolment works as smoothly as possible for the whole diversity of employment scenarios, such as the one to which my hon. Friend refers. The point about automatic enrolment is that where someone who is paid weekly exceeds the threshold once, they should be automatically enrolled. If in a subsequent week they earn below the threshold, nothing happens—no payment is due and no payment is made. If they go above the threshold again, payment is made, but there is no re-enrolment, disenrolment or leaving of the scheme. The complexity is often in perception, rather than in reality. If she is aware of individual employers who have particular problems, I would be pleased, as always, to receive details.

Gregg McClymont: May I press the Minister further on the question asked by my hon. Friend the Member for Brent North (Barry Gardiner)? The Government have changed the rules on pension flexibility at retirement, or are in the course of changing them, yet there are members of pension schemes who will face huge exit penalties if they wish to take advantage of those flexibilities. Does he think pension savers in that situation will be comforted by his saying today, “Well, they entered into a contract and they have to put up with it”? The Government are changing the rules, so surely those savers deserve to be able to take advantage of the flexibilities just as much as anyone else.

Steve Webb: I do not think that the hon. Gentleman in his heart of hearts really wants these flexibilities. We announced in the Budget the flexibility for people to access their money at 55, in full and in cash if they want to do so. Clearly a minority of schemes—it is important not to exaggerate the scale of this—have contractual terms that relate to the basis on which money can be withdrawn. We are not overwriting the rules of existing schemes, but we are talking to the industry to ensure that as many people as possible can access their cash.

Personal Independence Payment

Nick Smith: How long the average wait for an assessment for a personal independence payment was on the latest date for which figures are available.

Heidi Alexander: How long the average wait for an assessment for a personal independence payment was on the latest date for which figures are available.

Bridget Phillipson: How long the average wait for an assessment for a personal independence payment was on the latest date for which figures are available.

Mark Harper: The straightforward answer is that claimants have to wait for too long. We are committed to putting that right by clearing backlogs and improving processing time. Analysts in the Department are currently considering what information we should
	publish in future. We will pre-announce that publication in due course, in line with the UK Statistics Authority’s code of practice.

Nick Smith: How much has the Department for Work and Pensions returned to the Treasury because of the delayed implementation of the PIP?

Mark Harper: The Department has not returned any money to the Treasury as a result of the delays. There have been delays in processing these payments. I know they cause issues for constituents, which is why my right hon. Friend the Secretary of State made a clear commitment to reduce the waiting times by the autumn and then again by the end of the year. One of my top priorities, having started this job in July, is to get that reform process under way so that we can deliver that improved performance to benefit all our constituents.

Heidi Alexander: One of my constituents, a single mum who has been undergoing chemotherapy for breast cancer, waited over nine months for her PIP claim to be processed. It was sorted out only after my intervention. When will the Minister admit that it is not just how long the claims are taking to process but the fact that the system is utterly shambolic that is causing untold hardship to many people who are already living in very difficult circumstances?

Mark Harper: I would say two things. Clearly, I am disappointed to hear about the circumstances that the hon. Lady’s constituent has faced, which is why we are focusing on improving the system. My predecessor, my right hon. Friend the Member for Hemel Hempstead (Mike Penning), put a lot of work into improving the position for constituents who have terminal illnesses. We have made significant strides there, reducing processing times almost to the level we would expect, which is a matter of days. We are now focusing on other claims, so that constituents such as those of the hon. Lady will not have to wait for that length of time in the future.

Bridget Phillipson: In his earlier response, the Minister said that claimants are having to wait too long, but is it not the case, as Atos acknowledged in an e-mail to me, that that is on average 26 weeks? Surely it is wholly unacceptable to leave people in hardship and distress while they wait. What will the Minister do to sort out that chaos?

Mark Harper: First, I agree that the wait is too long. My right hon. Friend the Secretary of State has made it clear that no one should be waiting longer than 26 weeks by the autumn, and 16 weeks by the end of the year, and we will make sure that that happens. As regards hardship, PIP is not an income-replacement benefit for those out of work. It is paid in work and out of work. There are other benefits available such as employment and support allowance, which can help those people who have lost their jobs through no fault of their own.

Nigel Mills: What scope is there for increasing the number of people who can get PIP without having to go through the medical assessment? If written evidence is clear that they are entitled to it, why waste everyone’s time by going through an assessment?

Mark Harper: I agree with my hon. Friend. It is a relatively new benefit, and what we are trying to ensure is that in cases where there is clear medical evidence for the impact of someone’s disability, the decision can be made without their having to come in for a face-to-face assessment. That was not happening enough in the earlier stages; it is one of the improvements that we are making.

Charles Hendry: A constituent has contacted me to tell me that when he turned up for his assessment he was told that it had been cancelled because there were too many people waiting, so he was sent home. He then missed two further appointments, arguably through no fault of his own, and has now been refused a further assessment. Will the Minister intervene to ensure that, as the first one was cancelled through no fault of his own and was a result of a mistake by the assessors, a new assessment can be booked for him as soon as possible?

Mark Harper: Clearly, I do not know the facts of the case. If my hon. Friend contacts my office after questions, I will of course consider it and see what we can do to ensure that his constituent gets an assessment and that if he is entitled to the benefit, he can receive it.

Stephen Mosley: May I first welcome the Minister’s refreshingly clear and straightforward response to the initial question? To get things right, we must first admit that things are not working perfectly. To that end, has he been able to assess how different assessment centres compare against one another and whether any good practice from one can be carried over to the others?

Mark Harper: My hon. Friend makes a very good point. He will know that we have committed to two independent reviews of the PIP assessment, the first of which will report to Parliament at the end of this year. Last week I had the opportunity to meet Paul Gray, who is carrying out that review, and I am confident that his report will give us lots of useful things that we can do to improve matters on top of the things that we already do.

Anne Begg: Delays in getting a decision are causing other problems which I hope the Minister will look into. First, people are waiting so long that the sum they eventually get from the DWP puts them above the capital limits, which can affect their income-related benefits and cause problems with their housing benefit. Secondly, there seems to be some sort of computer glitch that means that when somebody is on ESA and is then awarded PIP the ESA stops and it takes some time for them to get that payment. Will the Minister consider both problems?

Mark Harper: I will certainly consider the points that the hon. Lady makes. I am due before her Select Committee a week Thursday for an extensive session on the personal independence payment. I am sure that she will ask me that question then and I hope that I will have a detailed answer prepared for her in advance.

Older Workers

David Amess: What recent steps his Department has taken to support older workers.

Steve Webb: The Government have abolished the default retirement age, extended the right to request flexible working and given people more freedom in how they draw their pension pots to smooth the transition to retirement. We recently published “Fuller Working Lives: a framework for action”, which sets out the business case for employing older workers, and we have appointed Dr Ros Altmann as the Government’s business champion for older workers.

David Amess: Does the Minister agree that with changing demographics—for instance, on Sunday 5 October in Southend there will be the largest gathering of centenarians in the world ever—employers should recognise the experience that an ageing population has to offer?

Steve Webb: My hon. Friend is quite right that older workers have valuable knowledge and experience and that employers who fail to retain their older workers are losing important skills from their work force. However, I can assure my hon. Friend and the centenarians who will be attending his event in Southend that we do not require them actively to seek work.

Gerry Sutcliffe: What will the Government do to support those workers who, owing to the raising of the pension age in some key public services, might not be physically active enough to do their current jobs?

Steve Webb: The hon. Gentleman raises an important point. In a world where people will be of working age for potentially 50 years, assuming that they will do a single job for their whole life is increasingly unrealistic. We need to do a great deal more to enable people to transition into less physically demanding jobs. We have recently piloted something called the mid-life career review, which starts people thinking much earlier about what they might be able to do later in life and other courses of action that might be open to them. We also need to challenge employer attitudes, which we are doing.

Nick de Bois: Although unemployment in my constituency is down a welcome 35% and youth unemployment is down by 40%, unemployment among those over 50 has stubbornly not reduced by the same rate. Will the Minister therefore endorse and welcome Enfield North’s first online older employees forum, which we have set up, along with our older employees forum and jobs fair on 26 October?

Steve Webb: I am very pleased to hear about the activity in which my hon. Friend is engaged. We are not asking for charity as regards employing older workers, and we often find when we talk to employers that many of them get it already. They realise that recruiting and retaining older workers benefits both young and old in the work force, and we want to see a lot more of that.

Fiona Mactaggart: Why does “Fuller Working Lives” not recognise the difference in the experience of older women workers and older men workers? Older women are about four times as likely to be carers and the biggest pay gap is between women and men over 50. What are the Government doing about that, apart from appointing Ros Altmann?

Steve Webb: I wonder whether the hon. Lady has read the document, given that one of the key groups on which we focus is carers. We specifically state in the document that carers face particular barriers in the labour market and that is why we need more flexible employment, such as our extension of the right to request flexible employment to all workers as of this year.

Work Capability Assessment

Nia Griffith: How many people were awaiting a work capability assessment on the latest date for which figures are available.

Mark Harper: Between April and the end of July, the number of people awaiting an employment and support allowance work capability assessment fell by 75,000 to 637,000. It is worth saying, as I have said in answer to the hon. Member for Bristol East (Kerry McCarthy), that claimants will normally be in receipt of benefit while they wait for an assessment, and that any arrears due are paid once a decision is made.

Nia Griffith: The Work and Pensions Committee said in its recent report that the flaws in the system were so grave that simply rebranding the work capability assessment for eligibility for employment and support allowance by giving it a new contractor would simply not solve the problem. Does the Minister agree, and what changes will he make to the new contract?

Mark Harper: I am not going to prejudge at the Dispatch Box the detailed response I shall give to the Work and Pensions Committee’s detailed look at the work capability assessment, but clearly one of our key priorities is to continue Atos’s work to the end of its contract, get the new provider in place and ensure that the process is working. The Select Committee made some thoughtful remarks about steps for the future. We shall respond to them in due course, when I respond to its report.

Kate Green: I am delighted to congratulate the Minister on his new appointment.
	Last month, it emerged that some people have been waiting a year and more for a work capability assessment—we heard that again from my hon. Friend the Member for Bristol East (Kerry McCarthy) this afternoon. The Minister is right that many of those people will receive some benefit while waiting for their claim to be processed, but they may also be subject to inappropriate conditionality and a deep sense of uncertainty and insecurity. What action is he taking to ensure that assessments and claims are finalised within 13 weeks, as the Government intended?

Mark Harper: I thank the hon. Lady for welcoming me to my post. I agree with her. She is absolutely right—I have said that we want to drive down the length of time that people are waiting. My priority is, first, to ensure that Atos performs against its commitments to the end of its contract in February, that we get a new contract awarded to a new provider, and that the new provider picks up the reins smoothly from Atos and continues to drive down the backlog, so that our constituents wait as little time as possible. Those are the things I shall be focused on between now and the election.

Pensions Advice

Robert Flello: What progress he has made on the introduction of face-to-face pensions advice.

Steve Webb: Our summer response to the consultation “Freedom and choice in pensions” outlined the policy and legislative details underpinning the implementation of the guidance guarantee. We will bring forward amendments to the Pensions Schemes Bill to introduce the guidance guarantee, and the Treasury implementation team continues its extensive service design work. We will publish an update note on the project in the autumn.

Robert Flello: Despite the announcements made in the summer, I understand that the pensions industry continues to express considerable concern about funding the guarantee levy, whether the service will be ready in time and how the scheme will operate. I understand that there is also widespread concern among consumers about how the scheme will operate and whether it will be ready in time. Given that this is perhaps the most important decision that people will face in their lives—it is certainly one of the most important decisions—and that there is concern that people will receive guidance and think it is advice, or that the guidance will not be comprehensive enough, what will the Minister do to ensure that the proposal works properly and quickly?

Steve Webb: We are actively engaged in making those preparations, but we entirely accept that the time scale is tight. I contrast our proposals with the current situation, in which hundreds of thousands of people reach an age at which they choose whether or not to buy an annuity and get no guidance, advice or help whatever. This will be free. The guidance will be independent and will be face to face if people want that. It will be a vast improvement on what currently happens.

Paul Burstow: Given that this decision is one of the most important that people make, and that one point they will consider is how they might meet the costs of their long-term care later in their old age, will the Minister take the necessary steps to ensure that this advice covers how to make the right decisions on paying for long-term care?

Steve Webb: My right hon. Friend has a strong track record on long-term care and making it affordable—he and our right hon. Friend the Minister of State, Department of Health, have introduced legislation on that. On the guidance guarantee, I have to be slightly wary of trying to jemmy in large numbers of different topics, but it is
	clear, as my right hon. Friend says, that retirees need to think about financial liabilities later in retirement. The guidance conversation offers an opportunity to start that process and to signpost people to places where they can find further information.

EU Migrants (Benefits)

Stephen Metcalfe: What steps he is taking to limit the availability of benefits to migrants from other EU member states.

Iain Duncan Smith: Since January, EU jobseekers have not been able to claim jobseeker’s allowance until they have been in the country for at least three months and can then claim for only a maximum of six months. Shortly, we will further limit the claim time from six months to three months. In addition, EU jobseekers cannot now claim housing benefit.

Stephen Metcalfe: Will my right hon. Friend join me in welcoming the recent fall in non-UK nationals claiming working age benefits, and will he do all he can to ensure that that trend continues?

Iain Duncan Smith: My hon. Friend raises an interesting point. Overall the total number of national insurance number registrations to adult overseas nationals is down by more than 7,000 on the year, or 1%. NINo registrations from outside the EU are down by 30,000 on the year, or 17%, and outside the EU annual registrations to all world areas have fallen to the lowest level since records began in 2002.

Ian Lucas: Will the Secretary of State confirm that when the Prime Minister finally reveals the shopping list for presentation to the European Union on renegotiation, it will include renegotiation of the position relating to benefits? Will he now specify which particular benefits he has in mind?

Iain Duncan Smith: I am not in a position to pre-guess what the Prime Minister will decide in his negotiations—he will make it altogether clear. But I hope that both sides of the House, including the hon. Gentleman, will recognise that a negotiation followed by trusting the people to vote on whether they wish to stay in the EU is a good plan rather than a bad plan.

Tim Loughton: I congratulate the Secretary of State on the introduction of a much more robust test before people qualify for benefit, but what discussions has he had with his European partners on further steps to prevent benefit tourism and to get the message across that the UK is a place where people come to work, not to claim?

Iain Duncan Smith: I have visited and talked to a number of my colleagues across Europe—in Germany, Holland, Spain and France—and I have also talked to the Danish Minister. Everyone to whom I have spoken so far and many more—I see that the Poles have also come to the same conclusion—have decided that there is something fundamentally wrong with the European
	Commission interpretation of people’s right to access benefits in a country where they do not have residency. Recently, the Germans have tightened up in almost exactly the same way as we have done. We had all those people saying that what we were doing was terrible, but now that the Germans are doing it, those people have gone quite quiet.

John Redwood: Is not the question of who gets a benefit from this country, or who comes to stay in this country, a matter for this Parliament, not for the EU?

Iain Duncan Smith: That is exactly the point that I have been making from the beginning. We have always said to the European Commission that this matter lay outside the treaties. It is a national Government responsibility, and it is national Governments who should take that responsibility. The Opposition did very little about organising this so that they would be able to stand against the EU Commission on that basis.

Benefits (Expenditure)

Philip Hollobone: How much his Department spent on benefits in 2010; and what estimate he has made of such spending in 2015.

Iain Duncan Smith: In 2010-11, the Department for Work and Pensions spent £54 billion on working age claimants and children at today's prices, and £106 billion on pensioners. Total expenditure was 9.8% of GDP. In 2015-16, as a result of our changes, the Department will spend £54 billion on working age claimants and children at today's prices, and £116 billion on pensioners. Therefore, total expenditure is expected to be £170 billion, which is 9.6% of GDP. In this Parliament, we will therefore have saved cumulatively £50 billion, the equivalent of £1,900 for every household in the UK.

Philip Hollobone: Will my right hon. Friend confirm that for the first time in 16 years, thanks to his stewardship, the relentless annual increases in welfare spending have at last been brought under control, so that the proportion of our national output that goes on welfare spending has finally been controlled, allowing our economy more room to grow and more spending on important areas such as health and education?

Iain Duncan Smith: My hon. Friend is right. Last year, welfare spending fell in real terms for the first time in 16 years as a share of GDP, and will continue to do so. In 2010, spending was at 12.5%, and next year it will be at 11.9%. By 2015-16, the out-of-work benefit bill will fall back to pre-recession levels, down to 2.3% of GDP. It peaked under the last Government at nearly 3% of GDP.

Emma Lewell-Buck: The Government claim that they are tackling what they call dependency on welfare. In the north-east, the number of working households claiming housing benefit has shot up by two thirds because wages are failing to keep up with rent. Will the Secretary of State admit that without action to tackle low pay or deal with soaring rents, the welfare bill will continue to rise?

Iain Duncan Smith: The figure the hon. Lady did not give is that out-of-work housing benefit claims are falling, and that is because people who were claiming it are now going into work. That means that they are earning more money, which means that the likelihood of their being in poverty is far less. I wonder whether the hon. Lady would like to get up sometime and congratulate us on getting more people back to work and spending less on housing benefit as a result.

Independent Living Fund

Nicholas Dakin: What recent discussions he has had with representatives of local authorities on transition plans relating to the closure of the independent living fund.

Mark Harper: The Department continues to work closely with the independent living fund, and just last week I met the chief executive and chairman of the board of trustees. The independent living fund continues to work closely with all local authorities in England and the devolved Administrations in Scotland and Wales.

Nicholas Dakin: North Lincolnshire council tells me that it has insufficient information about the transfer to engage properly with recipients of the ILF to give them a better sense of their future. The Government have consistently failed to give assurances that the changes will not mean that recipients lose their independence. Will the Minister give that assurance today?

Mark Harper: I am surprised by the hon. Gentleman’s comments about his local authority, because the information provided to me is that local authorities actively engage with the ILF: they have attended more than 90% of the meetings with users. The hon. Gentleman will also know that the Government are fully funding local authorities and the Scottish and Welsh Administrations for the amount of money that would be provided to people under the ILF. If he has specific concerns, he and I should have a conversation.

Duncan Hames: As the Government are fully funding local authorities for this obligation, can there be any possible justification for councils removing support from current recipients of the independent living fund?

Mark Harper: My hon. Friend will know that local authorities have a statutory duty to make sure that they properly support those who require social care. A third of the 1.3 million people who already get social care—444,000 people—are of working age, compared with 17,000 who are beneficiaries of the ILF, so I think local authorities are well practised at this and should have no excuse for not doing the job properly.

Barry Sheerman: May I remind the Minister that while local authorities may be well practised, they are certainly used to the fact that more and more aspects of social care are heaped on them without their having the ability to pay? He is
	bankrupting local authorities up and down the country and should not make the excuse that this particular benefit is being funded.

Mark Harper: I agree that local authorities have had some funding challenges due to the appalling budget deficit we inherited from the Labour party. Local authorities can set priorities. When my own local authority in Gloucestershire was making its difficult spending decisions, it rightly put adult social care and child protection at the top of that list of priorities and I am very grateful that it did so.

Universal Credit

Nick Brown: When he expects the business case for universal credit to be fully signed off.

Iain Duncan Smith: I announced in December that Her Majesty’s Treasury has approved funding for the universal credit programme in 2013-14 and 2014-15. The final stage in Treasury approvals is sign-off of the full business case, which covers the full lifetime of the programme. We expect to agree that very shortly.

Nick Brown: The answer to a similar question two months ago was “very shortly”, but it is taking rather longer than the Secretary of State intended. What are the major outstanding issues between his Department and the Treasury, and where does universal credit now stand in the Cabinet Office’s traffic light system?

Iain Duncan Smith: Let me explain to the right hon. Gentleman that the reality is that we have agreed—I can run through the list for him—all the spending that is relevant to the plan that we set out at the end of last year. The final point relates to the full lifetime of that programme, which will take it all the way through, probably beyond all the years that anybody present will be in government. [Hon. Members: “Certainly you!”] To be fair, I do not think Labour will be in government given the way its Members behave. That is now being agreed and the reality is that it has to be done very carefully. I genuinely believe, from my discussions, that it will be signed off very shortly. The result will be that the programme will be seen for what it is: a programme that will deliver hugely to those who have the toughest lives and need the most support and help.

Tony Baldry: One can see the advantages of the introduction of universal credit to those whose lives are toughest, but will my right hon. Friend tell the House what the benefits to both employers and businesses might be once universal credit is fully implemented?

Iain Duncan Smith: I invite anybody in the House to visit areas where universal credit is rolling out—across the north-west, and even here in London—not to talk to the likes of myself but to the staff who operate the jobcentres, who will say that it has allowed them to get people started into work far quicker, so that they are taking work earlier and staying in work longer. It means that businesses on the high street can afford to take people on, to begin with for lower hours than they
	might otherwise have been able to do—in other words, not creating a job—and then expand it into a much fuller-time job, so improving the economy and improving lives.

Andrew Gwynne: The Secretary of State has merely repeated what his Employment Minister has already said—that the strategic outline business case is approved until the end of the Parliament—but of course, in parting, the previous head of the civil service said that
	“we should not beat around the bush. It has not been signed off”,
	and the National Audit Office has slammed universal credit for
	“weak management, ineffective control and poor governance.”
	When are the Government going to get a grip of this chaotic shambles?

Iain Duncan Smith: It is always nice to live in the past, but the reality is that if the hon. Gentleman waits he will see that this programme is running well and will be delivering, that this programme of universal credit will benefit everybody who needs the support they most need, and all the nonsense he is talking about will all go away.

Chris Bryant: But the truth of the matter is that this programme—the Secretary of State’s pet project—is being kept on a life-support system, and all he can say is that the Treasury has guaranteed another 247 days of funding, with nothing beyond the end of this Parliament. He comes here again and says exactly what he said on 9 July, which was that this was going to be approved “very soon”. What has gone wrong? Did the Chief Secretary to the Treasury and the Secretary of State take two months going on holiday, or are there real sticking points in the programme because, frankly, the sums do not add up?

Iain Duncan Smith: There are no sticking points, but these matters need to be agreed carefully. This test-first-and-then-implement process is the way all future programmes will be implemented. I just want to quote Mr Manzoni, the new chief executive of the Major Projects Authority, who made it clear to the Public Accounts Committee in June that universal credit is stable and on track with the reset plan. [Interruption.] He said that it is stable and on track with the reset plan, so whatever the hon. Gentleman wants to say, when this is signed off, I hope that he will come to the Dispatch Box and say that Labour Members fully support it and they will get on with it.

Youth Employment (Support)

Paul Uppal: What support his Department is providing for young people seeking employment.

Esther McVey: Young people are offered extra support through the Youth Contract and the Work programme. I am pleased to be able to say that we have seen the largest annual fall in youth unemployment since records began, and the youth claimant count is nearly 188,000 lower than at the 2010 general election. However, we are not complacent. There is more we can do, and we are piloting new schemes for additional support for 18 to 21-year-olds.

Paul Uppal: Since 2010, more than 2,660 people have started an apprenticeship in my constituency. Will the Minister elaborate on further Government initiatives to make sure that young people in particular receive invaluable work experience?

Esther McVey: I thank my hon. Friend for the work he is doing in his constituency by helping to set up the Wolverhampton employment network, bringing employers and the local college together. We are doing many more things: not only are there over 1 million more young people on apprenticeships now, but we have had 150,000 on work experience placements since 2012, and 60,000 in sector-based work academies. In his constituency, we have had 370 on work experience, and 120 in sector-based work academies.

Stephen Timms: Youth Contract wage subsidies were an attempt, albeit half-baked, to tackle youth unemployment, but they were abruptly scrapped just before the summer recess, despite an official promise that they would be available for people applying up until next April. Why have they been scrapped? Has the Minister seen that the CBI is pointing out that “young people are struggling”, and that the biggest single cause of long-term disadvantage is “unemployment early on”?

Esther McVey: It seems that only the Labour party is still calling for incentive schemes and guarantee schemes. Even Europe is now saying what a good job the UK is doing on youth unemployment and looking at how we are moving forward. We had a wage incentive scheme, but that has stopped because we are moving the money into other areas where it is needed more. That is the right thing to do—spending the money where it will be used most effectively and efficiently. As I said, we have had the greatest annual number of young people going into work since records began.

Disability Confident Campaign

Sarah Newton: What progress his Department has made on its Disability Confident campaign.

Mark Harper: In July last year, the Prime Minister launched the Disability Confident campaign, which sought to encourage employers to become more confident about employing disabled people. We have reached over 1,100 local and national employers throughout Great Britain, and have received more than 200 pledges from companies in their quest to have better employment outcomes for disabled people. My predecessor wrote to colleagues and I encourage them to hold Disability Confident events in their constituencies.

Sarah Newton: I thank the Minister for his response. May I convey to him how positive the Disability Confident events are, having joined one in my constituency this summer? Will he congratulate Pluss, a great social enterprise in my constituency that has worked with more than 500 Cornish businesses to enable more than 800 people to get into work?

Mark Harper: I am grateful for my hon. Friend’s question and for the work that she is doing. I am pleased to be able to congratulate Pluss. I think that I am right in remembering that I visited it when I shadowed this brief in opposition. The work that it does and the success of the event are testimony to its efforts to get more disabled people into work.

Ian Lavery: The outcomes for people on the Work programme who are unemployed on health grounds are simply abysmal. What will the Minister do about that?

Mark Harper: The important thing is to see whether people who have health conditions are able to work. If we put people through a work capability assessment and they are clearly not able to work at all, we want to ensure that they get the appropriate help, but if people can work, we want to ensure that they do. That is why we have the Work programme and other schemes that give people proper support to get them into work.

Employment (Lincolnshire)

Martin Vickers: What assessment he has made of recent trends in employment in (a) North Lincolnshire and (b) North East Lincolnshire local authority areas.

Esther McVey: Simply put, the trends for employment are up. In North Lincolnshire, employment is up by 2,400 over the year and in North East Lincolnshire, employment is up by 600. Just like in the rest of the country, employment is up.

Martin Vickers: I thank the Minister for her reply and for her visit to my constituency a few weeks ago. Does she agree that it is not just Government policy that is leading to the fall in unemployment, but the excellent work that is done at jobcentres, such as the work that she witnessed at Immingham a few weeks ago?

Esther McVey: I thank my hon. Friend for inviting me up there to see the good work that is done on the ground at his local Jobcentre Plus, including the initiatives that are happening through the flexible fund and the work that is relevant to that specific area. I had a long conversation with Stuart Griffiths, the area manager, who explained how they are helping young people and how they are helping more and more people into work.

Topical Questions

Henry Bellingham: If he will make a statement on his departmental responsibilities.

Iain Duncan Smith: Today, I welcome an important step in our new test and learn approach to delivering universal credit, with the launch of 11 robust evaluation trials to test support for vulnerable households. We are working with local authorities in a way that has not been done before to make available a system of universal support
	that is delivered locally and that offers tailored help to get online and budget effectively as individuals progress into sustainable work.

Henry Bellingham: Is the Secretary of State aware that since July last year, unemployment in my constituency has fallen by a very welcome 689 people? That means that nearly 700 more families have a new wage earner and hope for the future. That is surely a clear vindication of his reforms and our long-term economic plan.

Esther McVey: I welcome everything that my hon. Friend has said about what is happening in his constituency. Such things are happening right across the country. The coalition Government—Conservative and Lib Dem colleagues—are developing a better Britain for all of us.

Rachel Reeves: Two thirds of children in poverty now live in families in which somebody is working, and a record 5 million people are earning less than a living wage. In-work poverty is an injustice and an indignity to those who suffer it, but it also costs the taxpayer through the benefit system. Will the Secretary of State tell us by how much the spending on housing benefit for people in work is expected to increase between 2010 and 2018?

Iain Duncan Smith: I wish the hon. Lady had been listening to my answer to an earlier question—[Interruption.] No, the reality is that the number of people who are out of work and on housing benefit is falling. The number of those who are in work is rising. Under the last Government, we saw a rise in the number of people who were out of work and having to claim housing benefit. Let me also remind the hon. Lady, who has voted against every single measure we have taken, that our housing benefit reforms were set to reduce the amount of money. When the Labour Government left office, housing benefit was likely to rise to £26 billion. It will now rise at a far slower rate than that, because of the reforms that we have made to housing benefit.

Rachel Reeves: The reality is that housing benefit overall is going to go up in real terms from £23 billion at the beginning of this Parliament to £24.6 billion at the end of it. Housing benefit for people in work is forecast to rise by a staggering £12.9 billion between 2010 and 2018. Does that not show that taking action to make work pay would be a much more effective way of controlling housing benefit than the unfair and unworkable bedroom tax, which I and many of my colleagues will be voting to change this Friday, and which we need a Labour Government to repeal after the general election next year?

Iain Duncan Smith: The hon. Lady is in a hole and she really should stop digging. Let me remind her of what we had to take over when we came into government. Left unreformed, the bill that Labour left us with would have exceeded £26 billion in 2014-15. Instead, today, it is £24 billion—£2 billion less. Under Labour, in-work and out-of-work housing benefit claimant numbers increased, and those who were in more despair, being out of work, had to claim higher payments. Under us, homelessness is down 7%, half the peak that occurred under the last Government, and rent collection is currently
	98% higher than under the last Government. Also, housing association arrears fell during the last two quarters. All of that is better than anything that the last Government left us as a result of their record on spending.

Caroline Dinenage: A number of my constituents have experienced lengthy delays while waiting for a decision on a review of their personal independence payment application. That is a time of great uncertainty and stress for all concerned. In addition to the efforts that the Minister has already outlined, will he tell us what steps he will take to speed up the application, review and appeal processes?

Mark Harper: My hon. Friend will know from earlier answers the priority that we attach to this. As well as ensuring that the assessment can take place faster, we are also ensuring that the DWP decision makers will be able to cope with the increased number of cases as those cases move through the system, so that, once we have got the assessment process sorted out, those decisions will be made in a timely way which will benefit her constituents and mine.

Barbara Keeley: Ministers have talked about bedroom tax exemptions, but in reality these do not protect unpaid family carers. In fact, 60,000 carers are hit by the tax, and Carers UK has found that 75% of the carers it surveyed were cutting back on food and heating to make up the shortfall. Will the Minister now accept how cruel and unfair it is to make unpaid family carers pay the bedroom tax?

Mark Harper: The hon. Lady will know that the spare room subsidy is about making sure that people have the size of home that they are entitled to, and that if people regularly need carers to stay overnight, that is considered an acceptable reason for having an extra bedroom. She will also know that we have made considerable funds available to local authorities through the discretionary housing payments, many of which have not even been spent.

Richard Graham: I welcome the Minister’s commitment to reducing the waiting times for processing benefit applications. At a recent meeting that I organised for Atos, the DWP, citizens advice bureaux and MPs’ caseworkers in Gloucestershire, representatives of the CABs expressed their suspicion that DWP contractors were paid according to how many people they could take off benefits. Will my hon. Friend confirm that that is absolutely not the case? Will he also encourage CABs to work closely with MPs’ offices so that we can intervene sooner to help our constituents who have problems?

Mark Harper: I can confirm to my hon. Friend and constituency neighbour that contractors are not paid based on any sort of incentive arrangement to get people off benefits. They are paid to make an accurate assessment, which they then provide to departmental decision makers. Citizens advice bureaux should continue their work with MPs’ offices, which is incredibly helpful.

Stephen McCabe: Despite the Minister’s earlier optimism, is it not clear that it has all gone badly wrong when the Government can organise to pay disability benefits to an on-the-run convicted killer such as David Richards, who as I understand it just walked out of jail, but cannot organise for some of the poorest disabled people in my constituency even to have their applications assessed within six months?

Mark Harper: I am not familiar with the case that the hon. Gentleman raises, although I know he has written to me to raise some PIP cases. I have not yet confirmed this to him, so I confirm now at the Dispatch Box that I will be happy to meet him to discuss those cases.

Rob Wilson: In a few weeks, I will hold my eighth Reading jobs fair. At the previous seven, 20,000 jobseekers and 300 local businesses have already been welcomed. Will my right hon. Friend the Secretary of State join me in thanking all the businesses and partner organisations that have made that possible, and in welcoming the impact that it has had on reducing unemployment in the Reading area?

Iain Duncan Smith: I congratulate my hon. Friend on working closely with businesses to get people back to work. Will he also pass on our congratulations to the businesses, small and large, that have done their level best to help deliver 1.7 million new jobs since the Government came to power and to turn the economy around so that it is the best-performing economy in the whole of Europe?

John Spellar: With the lamentable record of the failures of Atos, the shocking delays in assessments, the injustice of the bedroom tax and the continuing scandal of the IT system for universal credit, why does the Secretary of State stay in the job?

Iain Duncan Smith: I remind the right hon. Gentleman that this Government have got more people back to work, that we now have record levels of employment, that we have cut the deficit and that we are getting the cost of delivering welfare down. We inherited a shambles, and we have turned that around. That is the purpose of government.

Jake Berry: Will my right hon. Friend join me in congratulating Rossendale jobcentre, which has just signed up nearly 45 people to its work experience programme, including me and my office? The first young person to come through my office on work experience, Liam, has just secured a job because of that work experience.

Esther McVey: First off, three cheers for Liam for getting his job through work experience, as many other people are doing across the UK. Nearly 200,000 people have been on work experience since 2011, more than 40% of whom have got a job. That just shows that people can have a positive future when they have a Government like this in charge.

John Robertson: My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) mentioned the carers caught up in the bedroom tax. How many of them are still caught up in it?

Mark Harper: The hon. Gentleman knows that, as I have just said, if someone has an overnight carer, that is a perfectly acceptable reason for having a room. He will also know that local authorities have been given significant sums in discretionary housing payments to deal with difficult cases that do not clearly fit the rules. Most local authorities are not spending the money that the Government have allocated to them.

Julian Huppert: On 11 March last year, I asked the Secretary of State about under-occupancy. I said:
	“Does the Secretary of State agree that no benefit reduction should take place until people have at least been offered somewhere appropriately sized and located?”—[Official Report, 11 March 2013; Vol. 560, c. 22.]
	The Secretary of State said, “I agree”. What has he done to deliver that?

Iain Duncan Smith: I remind my hon. Friend that we have given local authorities more than £300 million in discretionary housing payments. What they are meant to be doing right now—many of them are doing it, by the way—is finding people the accommodation that they require and supporting them through discretionary payments while they are looking for it. That is why we are saving £1 million a day and £500 million a year.

Alison McGovern: A constituent of mine, an older, experienced woman, recently told me that when she was made redundant she got barely any help from our local jobcentre. It was therefore no surprise to me to see recent figures showing that the Work programme is getting a job for only one in eight workers over 50. Who is going to fix that—those who are running the Work programme or Ministers?

Esther McVey: The Work programme has proved to be very successful. Some 1.5 million people who are long-term unemployed have been on it, and more than 500,000 of those have got a job. However, if that lady was only recently made unemployed, she would not
	have been going on the Work programme just then. We have a flexible fund to support people, and we are doing more to help people, extending their working lives.

Nigel Adams: I know that Labour Members do not like encouraging news, but youth unemployment in Selby and Ainsty is down by more than a third since the last election, and much of that is down to apprenticeships. Will the Minister join me in thanking the employers who are taking on those youngsters, and encourage them to turn up at my jobs fair—the fourth one in Selby—on 9 October?

Esther McVey: I certainly will—if you are an employer and have a job, please get down to the Selby jobs fair. That is absolutely right. That is what we are doing: we are getting the country back on its feet and helping young people as best we can—hence, we have more young people in work than since records began. I congratulate my hon. Friend on all the work he does on the ground.

Ian Paisley Jnr: Is the Secretary of State aware of the impending crisis to the stability of institutions in Northern Ireland as a result of the failure to implement significant reforms to the welfare system there? If he is aware of those threats, what message has he for Sinn Fein, which has failed to introduce those changes and appears to be more interested in the need of residents in Monaghan than those in Northern Ireland?

Iain Duncan Smith: Sinn Fein needs to face up to its responsibilities and cannot have it all ways. If it gets the welfare Bill through, it will benefit from the support that it will get, but it cannot sit in limbo land. I support what the hon. Gentleman has just said—it is time for Sinn Fein to get on and do what an elected Government need to do.

Stephen Lloyd: Will the Minister provide an update on when the decision on the moratorium on funding for deaf interpreters for Access to Work will be announced, because we have been waiting for a report from the DWP?

Iain Duncan Smith: Let me undertake to write to my hon. Friend as soon as I leave the House and give him the full details.

EU Council, Security and Middle East

David Cameron: With permission, Mr Speaker, I would like to make a statement on this weekend’s European Council, and on the measures we are taking to defeat extremism and keep our country safe.
	First, on the Council, we agreed that Poland’s Prime Minister, Donald Tusk, should serve as the next Council President, and Italian Foreign Minister, Federica Mogherini, should become the next High Representative for foreign and security policy. Donald Tusk made clear in his acceptance speech that he places a high priority on addressing Britain’s concerns over the EU, and I look forward to working with him in his new role.
	The Council spent most of its time focusing on the big international issues that have concerned us all this summer—the situations in Ukraine, Gaza, and the growing threat of ISIL in Iraq and Syria. I want to discuss each.
	The presence of Russian soldiers on Ukrainian soil is completely unjustified and unacceptable. I met President Poroshenko before the Council on Saturday, and with our support he was invited to address the Council. The real cause of this conflict is Russia’s refusal to recognise Ukraine’s independence and sovereignty. Decisions on Ukraine’s political and economic relationships should be for the people of Ukraine and no one else, but Russia appears to be trying to force Ukraine to abandon its democratic choices at the barrel of a gun. In the last two weeks we have seen a dramatic stepping up of Russian military support to the separatists in eastern Ukraine, including Russian troops fighting on the ground. We know from European history the grave danger of a nation state being threatened and undermined in that way, so the European Council agreed that the economic costs it has already imposed on Russia must be stepped up if Moscow persists with those indefensible actions.
	The Council was clear that new sanctions measures will be drawn up within a week. I do not accept the suggestion that sanctions are not having an impact. Capital has flown out of Russia, banks are short of finance, and the Russian stock market and rouble have fallen significantly. We have to show real resilience and resolve. Russia needs to understand that if it continues on the current path, its relationship with the rest of the world will be radically different in the future.
	On Israel and Gaza, we have all been deeply saddened by the violence there and the dreadful civilian suffering it has caused, particularly to innocent children. The Government have worked hard with our international partners to help bring about a sustainable ceasefire, and we warmly welcome the agreement reached in Cairo. The loss of life this summer has been truly appalling and the number of civilian casualties completely unacceptable—the life of a Palestinian child is worth the same as that of a child of any one of our nations—but support for a lasting settlement that includes a Palestinian state does not mean we should ever support the terrorist tactics of Hamas, which has rained down rockets on Israel and continually refused to accept ceasefires.
	We will continue to support Israel and Israel’s right to defend itself, but that does not mean we support every decision the Israeli Government take. Most recently, the appropriation of nearly 1,000 acres of land in the
	west bank near Bethlehem is utterly deplorable. Settlements are illegal under international law and will do nothing to create the kind of peace process we all want, and we urge the Israeli Government to reverse this decision.
	While I understand the many strong emotions around this tragic conflict, I am deeply concerned by growing reports of anti-Semitism on our streets in Britain. Let me be clear: we must not tolerate this in our country. There can never be any excuse for anti-Semitism, and no disagreements on politics or policy should ever be allowed to justify racism, prejudice or extremism in any form.
	On the terrorist threat that we face in the UK, we have all been shocked and sickened by the barbarism that has been witnessed in Iraq this summer: the widespread slaughter of Muslims by fellow Muslims; the vicious persecution of religious minorities, such as Christians and Yazidis; the enslavement and raping of women; and, of course, the beheading of American journalist James Foley, with the voice of what seems to be a British terrorist recorded on that video.
	The European Council conclusions could not be clearer:
	“The European Council believes that the creation of an Islamic Caliphate in Iraq and Syria and the Islamist-extremist export of terrorism on which it is based, is a direct threat to”
	every European country. On Friday, the independent joint terrorism analysis centre increased the threat level in the UK from substantial to severe, and we now believe that at least 500 people have travelled from Britain to fight in the region, in addition to 700 from France, 400 from Germany and hundreds more from countries including America, Canada, Austria, Denmark, Spain, Sweden, Belgium, the Netherlands and Australia.
	The Council agreed to co-ordinate action in cracking down on those travelling to fight in Syria and Iraq and ensuring that all European countries are taking the necessary steps to tackle this problem of radicalisation. We should be clear about the root cause of this threat: a poisonous ideology of Islamist extremism that believes in using the most brutal forms of terrorism to force people to accept a warped world view and to live in a mediaeval state. And we should be clear that this has nothing to do with Islam, which is a religion observed peacefully and devoutly by more than a billion people and one that inspires countless acts of kindness every day.
	To confront the threat of Islamist extremism, we need a tough, intelligent, patient and comprehensive approach to defeat the terrorist threat at source. We must use all the resources at our disposal—our aid, diplomacy and military—and we need a firm security response, whether that means military action to go after the terrorists, international co-operation on intelligence or uncompromising action against terrorists at home. Britain is already providing equipment directly to the Kurdish forces. We support US military air strikes against ISIL in Iraq, and we have secured a United Nations Security Council resolution to disrupt the flows of finance to ISIL, to sanction those seeking to recruit to ISIL and to encourage countries to do all they can to prevent foreign fighters from joining the extremist cause.
	Alongside a tough security response, however, there must also be the right political response. We know that terrorist organisations thrive where there is political
	instability and weak or dysfunctional institutions, so we must support the building blocks of free and open societies. In Syria, that means a political transition and an end to Assad’s brutality, which has allowed ISIL to flourish. In Iraq, that must begin with a new and genuinely inclusive Government capable of uniting all Iraqis—Sunni, Shi’a, Kurd, Christian and others—against the shared threat.
	The NATO summit in Wales this week will provide an opportunity for us to review the effectiveness of the international response so far and to discuss what more we should do to help the region overcome the ISIL threat. Britain will continue to consider what further role is in our national interests, including any further diplomatic, humanitarian or, indeed, military measures we might take.
	Let me turn to how we address the terrorist threat at home. We have already taken a wide range of measures, including stopping suspects from travelling to the region by seizing passports, barring foreign nationals from re-entering the United Kingdom, legislating so that we can prosecute people for all terrorist activity, even where that activity takes place overseas, and bringing forward emergency legislation, for instance to safeguard our use of communications data. We have also stepped up our operational response, with a fivefold increase in Syria-related arrests and the removal of 28,000 pieces of extremist material from the internet this year alone, including 46 ISIL- related videos.
	But I have said all along that there should not be a knee-jerk reaction or the introduction of sweeping new blanket powers that would ultimately be ineffective. That is not what those who work so hard to keep us safe actually want. They want a targeted approach that reflects a forensic focus on the threat we face and that protects their operational independence and decision making. To achieve this, there are two key areas where we need to strengthen our powers to fill specific gaps in our armoury: preventing suspects from travelling; and dealing decisively with those already here who pose a risk. I want to mention both briefly.
	First, on stopping people travelling in the first place, passports are not an automatic right. The Home Secretary already has the discretion to issue, revoke and refuse passports under the royal prerogative if there is reason to believe that people are planning to take part in terrorist-related activity. When police suspect a traveller at the border, however, they are not currently able to apply for the royal prerogative and so have only limited stop-and-search powers. To fill that gap, we will introduce specific and targeted legislation providing the police with a temporary power to seize a passport at the border, during which time they will be able to investigate the individual concerned. This power will include appropriate safeguards and, of course, oversight arrangements.
	The House should also be aware that our current royal prerogative powers are being challenged in the courts. I want to be clear: if there is any judgment that threatens the operation of our existing powers, we will introduce primary legislation immediately so that Parliament, not the courts, can determine whether it is right that we have this power. I can announce today that we will start preparing the primary legislation and consult Parliament on the draft clauses.
	As well as stopping people going, we must also keep out foreign fighters who would pose a threat to the UK. We already have important powers to block return: we can deprive dual nationals of their citizenship to stop them returning; we can bar foreign nationals on the basis of the threat they pose; and we legislated, in the Immigration Act 2014, to allow stronger powers to strip citizenship from naturalised Britons. But, of course, these powers do not apply to those who are solely British nationals, who could be rendered stateless if deprived of citizenship.
	Some have said that we should deal with this gap by criminalising travel to certain individual countries or fundamentally changing our criminal burden of proof. The Government are clear that it would be wrong to deal with the gap by fundamentally changing core principles of our criminal justice system. But it is abhorrent that people who declare their allegiance elsewhere can return to the United Kingdom and pose a threat to our national security. We are clear in principle that what we need is a targeted, discretionary power to allow us to exclude British nationals from the UK. We will work up proposals on this basis with our agencies, in line with our international obligations, and discuss the details on a cross-party basis. We are also putting our long-standing arrangements on aviation security around the world on a statutory footing. Airlines will have to comply with our no-fly list arrangements, give us information on passenger lists and comply with our security screening requirements. If they do not do so, their flights will not be able to land in Britain.
	Secondly, we need stronger powers to manage the risk posed by suspected extremists who are already in the United Kingdom. The Home Secretary can already impose terrorism prevention and investigation measures on security grounds, including overnight residence requirements and internet restrictions, but the intelligence agencies and the police believe they need stronger powers to impose further restrictions, and the independent reviewer of counter-terrorism legislation, David Anderson, agrees. So we will introduce new powers to add to our existing terrorism prevention and investigation measures, including stronger locational constraints on suspects under TPIMs, either through enhanced use of exclusion zones or though relocation powers.
	Dealing with the terrorist threat is about not just new powers but how we combat extremism in all its forms. That is why we have a new approach to tackling radicalisation, focusing on all types of extremism, not just violent extremism. This has included stopping the funding of organisations that promote extremism, banning hate preachers and ensuring that every part of government, from schools and universities to prisons, is focused on beating the scourge of extremism. As part of this, we are now putting our de-radicalisation programme, Channel, on a statutory footing. Anyone subject to our strengthened terrorism prevention and investigation measures will be required to engage with the Prevent programme.
	We are proud to be an open, free and tolerant nation, but that tolerance must never be confused with a passive acceptance of cultures living separate lives or of people behaving in ways that run completely counter to our values. Adhering to British values is not an option or a choice; it is a duty for all those who live in these islands. So we will stand up for our values; we will, in the end,
	defeat this extremism; and we will secure our way of life for generations to come. I commend this statement to the House.

Edward Miliband: I thank the Prime Minister for his statement.
	This summer of international instability has demonstrated the need for Britain to be engaged and build alliances across continents to tackle the problems that the world is facing, learning lessons from the past.
	On the EU summit, let me take the opportunity provided by the appointment of a new High Representative and Council President, which we welcome, to commend the excellent work of Cathy Ashton over the last five years, particularly in helping to mediate an inclusive settlement in Kosovo and in leading the efforts to persuade Iran to abandon its nuclear programme. She has served with distinction.
	On Ukraine, before the summer we were all appalled by the shooting down of Malaysian airliner MH17, and we need to face the reality that we have seen no let-up in Russian aggression and incursions into Ukrainian territory. If anything, the situation has got worse, not better. This continued Russian aggression must be met with a robust co-ordinated and united international response, which sends a clear signal to President Putin. Does the Prime Minister agree that now is the time for the EU to consider further sectoral sanctions, including in key areas such as defence, energy and financial services? Will he also tell us what plans will be put forward at the NATO summit to provide support to Ukraine?
	On the situation in Gaza, we deeply regret the appalling loss of life of more than 2,000 Palestinians, including many children, and of Israeli soldiers and civilians. We unequivocally condemn Hamas’s dreadful and murderous rocket attacks and defend Israel’s right to defend itself. In our view, however, the nature of Israel’s response in this crisis cannot be justified, and I agree that today’s annexation of Palestinian land is, in the words of the Prime Minister, “deplorable”. The truth is that history tells us that this appalling cycle of violence will continue unless there are meaningful negotiations towards a two-state solution. Will the Prime Minister tell us what steps he and the EU will be taking to be an insistent advocate for those negotiations? I join the Prime Minister, too, in saying that whatever our views on this conflict, nothing can excuse anti-Semitism wherever we find it, at home and abroad.
	On Iraq and Syria, ISIL’s campaign of terror against the innocent, including Yazidi and Christian minorities, and its grotesque acts of violence have shocked people across the country. ISIL presents a particular type of threat that cannot be ignored because of our sense of conscience in relation to those who immediately face its terror; because it threatens the democratic Iraqi state and seeks to redraw borders to establish a repressive and brutal state of its own; and because of the danger of the export of this ideology.
	At the same time, we must learn lessons from the events of the past decade, including the 2003 war in Iraq, and proceed with the requisite humility. That means being clear about our objectives and the means
	to achieve them, and always being conscious of the need to build legitimacy and alliances well beyond Britain and the United States. We support the US airstrikes that are protecting innocent people at risk from ISIL, and we believe it is right to provide crucial support to the Kurds’ military effort. However, as President Obama has said, defeating ISIL cannot be achieved by military means alone, so may I ask the Prime Minister some questions about that?
	First, I agree with the Prime Minister that there can be no defeat of ISIL without tackling the sources of its support in Iraq. Therefore, what role is the EU playing in ensuring that the new Iraqi Government promote a new settlement that does indeed end the years of exclusion of Sunni minorities?
	Secondly, ISIL would not be the force it is if other countries in the region had not overtly and covertly provided succour for its ideology, as well as financial and other support. Therefore, what discussions has the Prime Minister had, or will he have, with countries in the region, including our traditional allies, to make clear the stand that needs to be taken against ISIL and its ideology. What further steps does he think can be taken to encourage neighbouring countries, including Turkey, to tighten their borders to slow the flow of arms and fighters to Syria and Iraq?
	Thirdly, does the Prime Minister agree that any strategy to tackle ISIL needs the active engagement of neighbouring countries, including Turkey, Saudi Arabia and Iran? I agree with what he says about the need for a political transition in Syria. Can he say how he believes that can be achieved? Given the need for the multilateral approach I have talked about, can he say how he plans to use our chairmanship of the UN Security Council to build the alliances that are necessary?
	Our approach to defeating ISIL at home must have the same determination as we show overseas and proceed on the basis of the evidence. Just as we were shocked by the actions of ISIL, so people throughout Britain are appalled that British citizens are part of ISIL’s murderous activity. Our country’s streets have seen before the horror that happens when extremist ideology turns to acts of violence. I welcome the Prime Minister’s commitment to make it easier for police and border authorities to seize the passports of those participating in the conflict, and we will study and scrutinise his proposals. On his discretionary powers to exclude British nationals from the country, it is unclear what he is proposing. I am happy to engage in cross-party conversations but can he give the House a bit more information at this stage about what his proposals might consist of?
	With regard to the most serious, high-risk cases—where convictions in the courts cannot be achieved—I welcome the Prime Minister’s recognition that the independent reviewer on terrorism has made clear the inadequacies of TPIMs, in particular, the inability to relocate suspects away from their communities. Relocation was indeed a central part of control orders, and it was a mistake to get rid of them in the first place. Does the Prime Minister also agree that we need a mandatory and comprehensive programme of deradicalisation not just for those who will be under TPIMs but for those who have been on the fringes of extremism in Iraq and Syria? Further, does he agree that we need to stop young people being recruited to ISIL in the first place? Can I therefore urge him to overhaul the Prevent
	programme, which has become over-focused on the police response to extremism and needs to do far more with parents and communities?
	As we tackle the domestic consequences of ISIL, we will work with the Government to tackle the threat we face here at home. The events of the summer have underlined how turning our back on the complexities and instability of our world is not an option. We must also show that Britain has learnt the lessons of our history with an approach based on genuine multilateralism. In responding in that way, the Government will have our full support.

David Cameron: I thank the Leader of the Opposition for the points he made and the tone in which he made them. There is widespread, all-party support for most of the issues that we are discussing today. He is right to praise Cathy Ashton. Let me add my voice to his. She has done an excellent job. Of course, that job is not yet complete: she is still involved in some important negotiations, not least with Iran, and we wish her well.
	On Ukraine and sanctions, the right hon. Gentleman asked whether we were looking at further sectoral sanctions. Yes we are. The conclusions of the EU Council set that out. It is important that we fill in some of the gaps that have been left. For example, on financial sanctions, we need to ensure that we press home on things such as syndicated loans, which others have opposed and we have been prepared to support.
	We give financial and technical support to Ukraine. There is obviously a partnership between Ukraine and NATO, and NATO will undertake some exercises in the western part of Ukraine. I do not believe, however, that the right approach would be to arm the Ukrainian rebels. We should focus the support in the areas that I have identified. The best thing we can do to help Ukraine is to build the alliance across Europe and America for strong sanctions to demonstrate to Russia that the relationship with the rest of the world will be fundamentally changed.
	On Gaza, the right hon. Gentleman asked what we were doing to get meaningful negotiations under way. Let me mention one of the things we do: we are one of the most important funders of the Palestinian Authority. We want to encourage them to restore their authority in Gaza and that could be a stepping stone towards further negotiations.
	On ISIS, I agree with what the right hon. Gentleman says—there is no military solution. We should work with partners and countries in the region. We should learn the lessons from the past. I welcome his backing for what we are doing to help resupply and support the Kurds. We should continue to do that. He then asked a series of questions. In terms of pressure on the Iraqi Government to reach out to all parts of Iraq, we are part of the solid international pressure to ensure that that happens. On talking to powers in the region to ensure that financial support is cut off for extremism, those are conversations I have had with many over the summer and will continue to have. On Turkey, we are working more closely with Turkey than perhaps ever before on security, intelligence and other co-operation.
	On measures at home, I am delighted that the right hon. Gentleman is going to support our measures for seizing passports, although of course we are happy to
	discuss that on an all-party basis as we introduce this legislation. Again, I welcome what he says about all-party discussions on other discretionary powers to make sure that we correct the problems that we have in a proper way.
	On the right hon. Gentleman’s last two points, it is important that Prevent is focused on counter-radicalisation. In the past, some money was spent on organisations that were perhaps part of the problem rather than part of the solution. I believe it is very important that we target not just violent extremism but the extremist narrative from which the men and women of violence draw succour. I think that is important.
	Finally, on terrorism prevention orders and control orders, let me quote to the right hon. Gentleman what David Anderson, our terrorism adviser, who he quoted, said in his most recent report:
	“There is no need to put the clock back. The majority of the changes introduced by the TPIMs Act have civilised the control order system without making it less effective.”
	That is why we should take TPIMs as the basis and amend them as necessary.

Peter Tapsell: Does the Prime Minister recognise that one of the reasons why there are misguided British jihadists fighting in Arabia is the folly of those in the Gulf and in the west who first encouraged and then supported a Sunni rebellion against the Syrian Alawites? We must avoid, under the banner of democracy, intervening in a religious civil war that has already lasted for 1,300 years.

David Cameron: I always listen very carefully to the Father of the House but on this occasion I am not sure I agree with him. I would argue that the rise of Islamic State—of ISIS—has had two principal causes: one is the brutality that Assad has shown to his own people, and the second is the failure of the Government in Iraq to represent all of its people. We need to recognise that it is those two issues that have been the principal cause of this problem, together with, as I have said, the real problem, which is the Islamist extremist narrative that finds any broken state, any source of conflict, any sign of weakness, and exploits it.

Jack Straw: In an article that the Prime Minister wrote in The Daily Telegraph on 16 August, he spoke about the need to build alliances in the region, including, he said, perhaps even with Iran. Does he agree that, yes, while there is a negotiation to be had with Iran over the nuclear dossier, frankly, as he indicated, we need Iranian co-operation more than ever, as it is one of the few stable states in the region? Given that, could he say therefore what action he is taking to lead the full establishment of diplomatic relations with Iran, because the embassies have still not been fully reopened?

David Cameron: I greatly respect the right hon. Gentleman, and I know he has considerable experience of dealing with Iran, not least from when he was Foreign Secretary. As I have said here before, we are cautiously re-engaging with Iran—he knows about the steps already taken—and that will lead over time, I am sure, to the reopening of embassies and all the rest of it, but we should do so very cautiously, knowing Iran’s
	history and what it has done, including support for terrorist organisations. Clearly, what is most required in Iraq is an Iraqi Government who represent all of its people, and those that have been most excluded recently have been the Sunni population, but we need, of course, the assistance of Iraq and other countries in making sure this comes about.

Menzies Campbell: May I welcome the fact that my right hon. Friend’s statement was rather more nuanced than some of the reports have suggested over the weekend? May I take him directly to the question of the exclusion of United Kingdom nationals from the United Kingdom? Is he aware that there is very substantial doubt as to whether that would be legal, not least, of course, because of our international obligations in treaties and conventions? In addition, hardly anything has been said about the practicality of such a proposal. Who would decide, would any such suspension be without limit of time, and, indeed, would any appeal be appropriate? In those circumstances, a great deal of work needs to be done on the proposal he has outlined.

David Cameron: I respect the right hon. and learned Gentleman and the point he makes, and he is absolutely right: we should not be tearing up international obligations in order to bring this about. The point I am making is that, as we stand today, we are able to deal with foreign nationals who want to return to Britain—they can be excluded—and we can deal with dual-nationals because we can take away their British passport without rendering them stateless, but we have the example, for instance, of someone today, a British citizen, who says that he wants to come back to Britain in order to wreak havoc in our country and who has pledged allegiance to another state. So therefore there is a gap that needs to be properly discussed, properly identified and properly dealt with.

Peter Hain: I support air strikes on ISIS to stop its genocidal attacks in the region, particularly against Shi’a Muslims and Kurds and minorities, but there should be no question of British troops on the ground. However, we do need to support the Kurds particularly, in providing the equipment they need. In addition, neighbouring nations need to take ownership of this fight and the solution to it. Could the Prime Minister, therefore, press our close ally, the Saudis, to stop funding mediaeval barbarism by ISIS, and could he get Iran and Turkey to engage as well? Finally, could he schedule a full day’s debate in prime Government time on foreign policy? The world is a very dangerous place at the moment, including between Russia and Ukraine, and we need to have a proper debate, welcome though statements are.

David Cameron: On the right hon. Gentleman’s point about a fuller debate, we are looking at that: the House authorities are looking at it and I think it would be extremely worth while if time can be found. I very much agree with the tenor of what he says, which is that we should be looking to ask how we can best help those on the ground—the Iraqi Government, the Kurdish forces—who are doing their best to prevent humanitarian
	catastrophes and to make sure that Islamic State is properly addressed in Iraq? We should be asking how we can help, rather than thinking the west can somehow lead and overtake an intervention, but I agree with the right hon. Gentleman that there should be no question of British combat troops on the ground.

Richard Ottaway: I very much agree with the Prime Minister over the nature of the extremist threat we face, but during the summer recess there have been repeated calls for a coalition of the willing. He will have seen reports that Egypt and the United Arab Emirates carried out air attacks on the militia in Libya. Is there any sign that Arab states and the west will join together militarily to co-operate in combating ISIS?

David Cameron: My right hon. Friend’s contribution is along the same lines as that of the right hon. Member for Neath (Mr Hain): that we should be there to help those on the ground who want to get the right outcome, rather than thinking that we can magic a solution on our own. When we look at the attitude of the Jordanians and others, we see that they recognise the huge threat that Islamic State poses to them, but it also threatens us. Therefore, I think our approach should be about helping the Kurds, helping the Jordanians, helping the Iraqi Government—helping all those who, working together, can address this threat.

Hazel Blears: Last July the hon. Member for New Forest East (Dr Lewis) and I came to the Prime Minister’s tackling radicalisation taskforce and we asked for two things: first, for further action to expose the poisonous ideology of these extremists; secondly, for more support for Muslim communities themselves to be able to challenge these messages so the next generation of young people does not end up in the hands of the extremists. I am disappointed that today’s statement has very little to say about either of those issues. I am sure the Prime Minister has further proposals—practical, concrete, patient, measured and effective—and I would very much like to see them, as I am sure would most Members of this House.

David Cameron: I am disappointed that the right hon. Lady is disappointed, because when it comes to the issue of countering the extremist narrative, there are few people in any part of the House with whom I agree more. When we look at what the extremism taskforce achieved in terms of countering radicalisation in prisons, on campuses, in schools and, indeed, by working with Muslim organisations that want to deal with this problem—for instance by giving them legal assistance in throwing the extremists out of mosques or community centres—we see all those things are happening, but I will look to see what more can be done.

Dominic Grieve: May I congratulate my right hon. Friend on the broad thrust of his statement? But I have to say that I share the concern that has been expressed about the suggestion that British nationals, however horribly they may be alleged to have behaved, should be prevented from returning to this country. That would offend not only principles of international law, but basic principles of our own common law. I recommend to him that the best
	course must be to bring these individuals to justice, and he may wish to confirm to the House that we have actually been quite successful in doing just that over the past nine months.

David Cameron: My right hon. and learned Friend is absolutely right to say that our first approach should be trying to prosecute and convict people in our country. As he says, the courts—and the police and intelligence services—have been successful on that. The most important thing is to make sure, in listening to the intelligence services and the police, that any gaps in the armoury are properly addressed. That is why we are looking at the terrorism prevention and investigation measures and introducing this passport confiscation measure, but it is important that we discuss the issue of returnees as well.

Elfyn Llwyd: If the current UK security profile is as dire as we are led to believe by the Government, will the Prime Minister today give us all some comfort by reversing the 4,500 job cut plan in the Border Agency?

David Cameron: This Government have prioritised resources into those agencies most at risk when it comes to combating terrorism; the funding settlement for the security agencies has been generous compared with that for other organisations. I am very happy, with the pressures we face, to look again at the resources, and if more is needed, I am sure that more can be found, because nothing matters more than this. But let me say to the right hon. Gentleman that I know there are always suspicions when politicians stand up and talk about the threats we face to our nation. The joint terrorism analysis centre is the body that independently decides the level of threat facing this country. It decided, because of what is happening in Iraq and Syria—not just ISIL, but the other al-Qaeda offshoots—and because of the number of people travelling to that region from Britain and elsewhere, that it was right to raise the level from substantial to severe. It is its decision, not mine.

Liam Fox: What discussions has my right hon. Friend had with other leaders about stopping the sale and purchase of ISIL oil on the black market, which is one means by which ISIL sustains itself? What discussions has he had about stopping financial flows through the international banking system to ISIL? In what circumstances would the United Kingdom decide to join, rather than simply support, US air strikes on ISIL military positions?

David Cameron: On my right hon. Friend’s first points, he is absolutely right to say that those are things we should pursue. I also believe we should publicise more the fact that ISIL makes a lot of money from selling oil to President Assad—that demonstrates the character of these people. On our engagement in the efforts that are being made, we have brought to bear diplomatic, political and other tools in our armoury. We have also used our military. They have been delivering aid in Iraq, and providing surveillance and other capabilities that are helping the Americans. We support the American air strikes; we think they are right. That has been our approach to date, and I think it is right, as I say, to keep asking the question: how can we, in Britain, best pursue
	our national interest—keeping our country safe—and help those people on the ground who are doing the most to combat ISIL?

Caroline Lucas: The Prime Minister has pledged that we will stand up for our values, and I hope we will. So can he explain how it is compatible with our values, and indeed how it helps tackle Islamist extremism, to continue to sell arms to countries such as Saudi Arabia, which regularly beheads its own people and which is one of the most significant sources of funding to extremist groups worldwide?

David Cameron: We have some of the toughest rules on arms exports of any country anywhere in the world. Those rules are subject to the rule of law, and we have to make sure that they are. We would of course take a very different view on many of the domestic rules and regulations in Saudi Arabia, but I think it is true to say that the Saudi authorities have changed their approach on radicalisation around the world, and it is worth while that they do so.

William Cash: On the matter of statelessness and preventing British terrorist jihadists from returning to the United Kingdom, has my right hon. Friend been briefed that, under article 8 of the United Nations convention on statelessness, domestic legislation in certain countries may render a person stateless where he has acted inconsistently with his duty of loyalty, has behaved in a way prejudicial to the interests of the state or has declared allegiance to another state and shown evidence of repudiation of allegiance? Does he not accept that that is exactly where we are now, and that it would be extremely important to get that right so that the Leader of the Opposition understands that the matter can be made clear?

David Cameron: My hon. Friend makes a good point, which shows exactly why we need to discuss and examine this issue further. The reason why everyone will want us to examine this is that it absolutely sticks in the craw that someone can go from this country to Syria, declare jihad, make all sorts of plans to start doing us damage and then contemplate returning to Britain having declared their allegiance to another state. That is the problem that we need to address, and my hon. Friend will be useful in doing so.

Gerald Kaufman: Does the right hon. Gentleman recall that when he made his previous statement on Gaza, I said that the Israelis could kill but they could not win. Seven weeks later, 2,000 Palestinians, including 500 children, have been killed by the Israelis and an enormous amount of physical damage has been inflicted that makes life in the Gaza strip next to impossible. What will the Government do to prevent another such attack, which will come at some time or another if not stopped, and will he now impose an arms ban on Israel?

David Cameron: What we must do is convince everyone that it is worth while getting round the table to find a negotiated solution to the fundamental underlying issue of the need for a Palestinian state. To do that, we must persuade the Israelis to make it a greater priority and to understand that that would be the true route to
	security. We also need to persuade the Palestinians and those who have supported Hamas that terrorist attacks and rocket attacks on Israel will not bring Palestinian statehood closer.

Alistair Burt: My right hon. Friend is absolutely right to protect the United Kingdom against the threat that it faces, but the most immediate threat in the region is faced by those states around ISIS which find their borders being dissolved and which first bear the brunt of the need to protect innocent civilians. We can help, and there are those who are bearing a burden even now. Has my right hon. Friend received a specific request for arms from the Kurdish Peshmerga, either directly or through the EU? If he has, how are we responding? If he has not yet received that request, how will the Government respond?

David Cameron: I am grateful to my right hon. Friend for his question. So far we have received requests from the Kurds to facilitate the transfer and transport of arms and ammunition from Jordan and Albania to the Kurdish regional authorities. We have done that, and it is absolutely right that we have. I am not aware of a specific request directly from the Kurdish regional authorities for arms and military support, but as I have said before, we would look very favourably on such a request. They are our allies and friends, and we believe that they are helping to put the pressure on ISIL and to defend communities. We very much want them to be part of a future Iraq rather than anything else. With those provisos, we take a very positive view.

Gisela Stuart: Further to the previous question, German Chancellor Merkel has decided that it is in Germany’s national interest to provide the Kurds with arms. Will the Prime Minister tell me when he thinks that it would not be in Britain’s national interest to do so, or what he would require to make him change his mind?

David Cameron: With respect, I do not think that there is any difference in what the German Chancellor is saying and what I am saying about this. If the Kurds were to make a specific request, we would look on it very favourably because we think that they should be properly armed and equipped to deal with the threat that they face.

Martin Horwood: Is not the truth that the European Union has so far failed adequately to respond to Russia’s increasingly flagrant aggression in Ukraine, not even stopping the imminent delivery of French amphibious assault ships to Russia? Does not next week’s NATO summit need to send a much stronger signal and perhaps even offer to buy those amphibious assault ships for NATO not Russia?

David Cameron: That is a very interesting suggestion that I can take on board. It is not easy to get to 28 countries around a table to agree on sanctions and to try to do that at the same time as the United States of America, but I would argue that by and large in recent weeks and months that is what we have done. Although of course I want sanctions to go further and to have a
	greater effect—as I said in my statement, they are having an effect and have brought pressure to bear—we need to signal not when more Russians appear on Ukrainian soil that we will somehow back off or give up, but that we will turn the ratchet and that Russia will suffer permanently from the increasing economic isolation that follows.

Stephen Doughty: The Prime Minister will be aware that a number of individuals from Cardiff, including two from my constituency, have travelled to join and fight with IS in Iraq and Syria. Will he explain to me how a young man believed to be at risk has apparently been able to obtain and use a UK passport to travel using commercial means from the UK through the EU to fight for IS? Does the Prime Minister have full confidence in Her Majesty’s Passport Office and the UK Border Force and will he assure us that there have been no serious lapses in their existing checking procedures, particularly given the numbers that we have seen going to fight?

David Cameron: I will certainly look at the individual case that the hon. Gentleman produces. We could not have given clearer instructions to the agencies concerned about confiscating passports and preventing travel. A number of passports have been confiscated and a number of people have been prosecuted, but we obviously need to do all we can and more to stop this happening.

Rory Stewart: Given the situation in Ukraine, when will the Prime Minister investigate committing towards pre-positioning equipment in the Baltic and ensuring that there is a British battalion under the command of the Supreme Allied Commander Europe to be deployed in rapid reaction and that we make a binding, statutory, long-term commitment to 2% of GDP for defence?

David Cameron: I welcome this question and congratulate my hon. Friend on his election to head up the important Select Committee on Defence in this House. Many of his suggestions will be directly addressed at the NATO conference. I think it is very important that when Russia looks at countries like Estonia, Latvia or Poland, it sees not just Estonian, Latvian and Polish soldiers but French, German and British soldiers, too. We need to make real our article 5 commitments, and that is very important. We have already taken steps to help with Baltic air patrolling, for instance, which has been gratefully received by the countries concerned.
	As for defence spending, I am proud of the fact that we are one of the very few countries in Europe—two at the last count, I think—to meet the 2% figure for defence spending, and we should use the conference in Cardiff to urge others to do the same.

Dennis Skinner: Is the Prime Minister aware that his words would be much more credible if his view and reading of history were as good as all the stuff—the garbage—he trots out? Namely, 12 months ago this Prime Minister stood at that Dispatch Box and tried to get the House of Commons to join him to help and arm the ISIL guerrillas against Assad. Had it not been for the Labour party, he would have been
	trapped on this hook. He wants to get on his hands and knees and thank the Labour party for not taking Britain down that route.

David Cameron: My memory of the discussions we had a year ago is that they were about the use of chemical weapons. My reading of history is that the use of chemical weapons is wrong and we should not turn away from it.

Gerald Howarth: I join my right hon. and hon. Friends in congratulating the Prime Minister on his robust stance in pointing out the poisonous nature of the IS ideology, but will he go further, in accordance with a suggestion from my right hon. Friend the Member for North Somerset (Dr Fox)? ISIL represents a substantial threat to the continued integrity of Iraq, and American airstrikes have been successful in halting its further advance. Would it not be better for the Royal Air Force to join in that measure? As far as Ukraine is concerned, may I repeat my plea for the Prime Minister to use this weekend’s NATO conference to get a NATO maritime force to position itself in the Black sea to deter Putin from engaging in an attack on Odessa?

David Cameron: First, we support the action the Americans have taken to assist the Iraqi authorities and Kurdish authorities in beating back ISIL; that has been the right approach. We have also assisted in our own way through the humanitarian aid we have delivered and the intelligence and other support that we have given to the Americans. That is the position.
	On Ukraine, I do not think that the approach my hon. Friend suggests is the right one. We should be demonstrating that NATO stands behind all its members, as I have just said. We should be demonstrating that NATO has important partnerships with countries such as Ukraine. Indeed, that should not stop us having exercises in Ukraine, as we will do later this year. However, I do not believe that the solution to the problems in Ukraine is a military solution. We want a de-escalation of the military situation and an escalation of the political solution, recognising that, at heart, the Ukrainian people must be able to choose their future. It is that that Russia is trying to deny.

Derek Twigg: When did the Prime Minister realise that the Iraqi army could not deal with ISIL, and does he believe the Iraqi army will be in any position soon to defeat ISIL?

David Cameron: The weakness of the Iraqi army was based not on its equipment or even on its training, but on the fact that it was seen as a force that represented only one part of Iraq. That demonstrates the importance of focusing on politics as well as on military issues. What is required—I think the Iraqi army will not succeed until this happens—is a Government of Iraq who represent all of Iraq, and Iraqi security forces that can make the same claim.

John Redwood: Do not recent events show the need for us to control our own borders? Should not that be central to our new relationship with the EU, so that its weakest border is not our border?

David Cameron: Of course, we are not members of Schengen, so we are able to police our borders independently, which we do. Indeed, it is at our borders that we can restrict people coming in, and after the legislation, as well as the royal prerogative of taking away people’s passports, we will be able to take them away at the border too.

Frank Dobson: I hope the Prime Minister accepts that no one in the House is more opposed to terrorism than I am—my constituency was subject to the Tavistock Square and Russell Square bombings. Does he agree that to be a British citizen is very precious, and that we need to be very careful about interfering with the rights of British citizens? If the security services know enough to finger people and say that they cannot come into the country, why can we not arrest and prosecute them and subject them to our general laws? If we do not subject all British citizens to our general laws, is there not a possibility that other countries may not attach enough significance to British citizenship?

David Cameron: I very much respect the right hon. Gentleman’s views. Of course I agree with him that the best outcome when we are faced with a terrorist threat is to ensure that we can gather evidence, prosecute and convict those who threaten our country. That is the first option, but successive Governments have found that, when we are facing an existential terrorist threat, that is not enough. That is why, in the past, we had control orders, and why we now have terrorism prevention and investigation measures. It is why, sometimes, we have to take extraordinary measures, such as using the royal prerogative to take passports away. I would argue that stripping someone of their nationality is not sacrosanct—that is what we do in the case of dual nationals today. That is why we must address any potential gap in our armoury so that we can keep our country safe.

Nadhim Zahawi: I commend the Prime Minister for his diplomatic, security and humanitarian efforts to help the people of Kurdistan against the threat of ISIL. When I was there, I was told that ISIL was issuing passports and visas. We should recommend that any British citizen who pledges allegiance to ISIL should get that passport, not a British one, and that the British one should be withdrawn immediately.

David Cameron: It is worth listening to my hon. Friend. I am grateful for the travel he undertook to the Kurdish regional authority, and for the work he is doing to build our relationship with President Barzani. It is hugely helpful. I listened carefully to the other point he has made.

Jeremy Corbyn: Will the Prime Minister explain why the British Government did not support the call made by the United Nations High Commissioner for Human Rights for an investigation of war crimes in Gaza, and why Britain and the other European nations abstained on that vote? Of course, the inquiry is going ahead. In the meantime, the Prime Minister has continued an armed relationship with Israel, despite 2,000 people dying in Gaza. Does he not think it is time to suspend arms deals with Israel because
	of the appalling loss of civilian life in Gaza, the continued occupation of the west bank, and the continued theft of Palestinian land by the Israeli occupying forces?

David Cameron: It is right that these claims and points are properly investigated. The reason for not voting for the specific motion was that it was unbalanced, and that was the view that many other countries took. With regard to arms exports, the Government have reviewed all existing export licences to Israel. The vast majority were not for items that could in any way be used by Israeli forces in operations in Gaza. Twelve licences were identified for components that could be part of equipment used by the Israeli defence force in Gaza, and no new licences for military equipment were issued for use by the Israeli defence force during that review period. That is the approach that we have taken, which has been sensible and balanced.

Tony Baldry: Donald Tusk has indicated that he is ready to support my right hon. Friend’s plans to introduce new limits on welfare payments to migrant workers from other EU states, and has made it clear that the European Union needs to find solutions to meet the UK’s legitimate concerns about EU membership. Does not that demonstrate that it is possible for the UK, under my right hon. Friend’s leadership, to negotiate real and positive changes in our relationship with the EU?

David Cameron: I very much agree with my right hon. Friend. May I say, in respect of his announcement today that he will not be standing at the next election, how much his wise counsel will be missed in the House and in our party?
	Donald Tusk said:
	“The European Union and I personally will surely respond to concerns signalled by Great Britain…I talked about it to David Cameron and I also understand many of his attempts and proposals of reforms and I think that they can be accepted by sensible politicians in Europe…also regarding the search for a compromise aiming to eliminate abuses in the free flow of labour.”
	This is a positive statement, and as I said, I am looking forward to working with him in the future.

Chris Bryant: The Prime Minister has said that there are Russian troops on the ground in Ukraine, which gives the lie to what President Putin has been saying for the last week. Since President Putin’s Russia is behaving like an international terrorist organisation in itself, following the question that I asked the Prime Minister in July on the Magnitsky case, on the basis of which he sent me a letter over the summer, can he not now, unambiguously, finally say, without any element of uncertainty, that those who were involved in the murder of Sergei Magnitsky and in the corruption that he unveiled are not welcome in this country? Just a straightforward “They are not welcome”—end of story.

David Cameron: I am afraid that I do not have the letter in front of me, but I do not really have anything to add to the letter I sent to the hon. Gentleman. But he is absolutely right that it is quite clear that the Russian authorities have not told the truth about the situation in Ukraine.

Edward Garnier: I thank my right hon. Friend for not urging upon us, despite provocations—no doubt from many—a slew of new legislation, and not taking up a desire to re-write old legislation as though it were new legislation, but targeting his thoughts on one or two specific areas. Will he make sure that the deliberations on the new legislation that he is suggesting are as wide as possible and that we take time to get it right rather than rush it through to achieve a quick result?

David Cameron: I heard my hon. and learned Friend’s calming tones on the radio this morning, which set the tone for my whole mood today. He is right. I do not believe in knee-jerk responses. We are a country under the law, we have very firm rules in this area and what are required are some changes at the margin to fill in the gaps that we have identified. We should not spend too long debating and discussing those gaps, because if there are gaps they need to be filled quite urgently.

Ben Bradshaw: Why is the Prime Minister still sending weapons to the Netanyahu Government in Israel while being so slow to arm the Kurds and refusing to arm the legitimate Government of Ukraine?

David Cameron: We are operating the legislation that in part was put forward by the Government of whom he was a member.

Julian Lewis: Does the Prime Minister agree that one of the main reasons why NATO successfully deterred and contained the then Soviet Union from 1949 to 1989 was that the rulers in the Kremlin were in no doubt at all that an attack on one NATO country would inevitably mean war with all the rest? For that reason, at the NATO summit will he bear in mind the fact that NATO membership, however hard-hearted this may seem, must never be offered to a country unless we are prepared to go to war to defend that country?

David Cameron: My hon. Friend speaks very good sense about this. Article 5 obligations are deadly serious and we would have to meet them if a NATO member was invaded by another country, so the point he makes is a good one.

Hugh Bayley: In Kiev over the summer the Ukrainian Prime Minister said forcefully to me that, whereas the pro-Russian rebels in eastern Ukraine are fully and adequately armed by Russia, his own state Ukrainian forces do not have all the matériel they need. Will the Prime Minister tell the House what military advice and assistance we are giving to the Government of Ukraine?

David Cameron: As I have said, the assistance we have given Ukraine to date has been in technical, financial and governmental areas. We stand open, of course, to having discussions with it on a military-to-military basis, but providing arms has not been part of our plans.

John Baron: The policy of talking loudly but carrying a small stick is often found wanting quite quickly. Does the Prime
	Minister concede that cutting 20,000 front-line troops risks sending the wrong message not only to our potential adversaries, but to our NATO partners as he rightly prepares to encourage them to increase their defence spending?

David Cameron: I am afraid I do not agree with my hon. Friend, for this reason: we have had to make difficult decisions in order to deal with the deficit, but no one can describe a £33 billion defence budget—one of the top five budgets anywhere in the world—as a small stick. Because we have taken difficult decisions, we have got a new aircraft carrier, with another to follow, the Type 45 destroyers, the Astute submarines, the best-equipped Army that I think we have had for many years and, of course, a whole new range of aircraft for the RAF. You can only have that size and sort of stick if you take the difficult decisions elsewhere in your budgets.

Pat McFadden: The decision to water down control orders was the wrong policy taken for the wrong reasons, and I welcome the Prime Minister’s at least partial U-turn today on the relocation element.
	On the international dimension, it is right to learn the lessons from the past, but it is wrong to be imprisoned by the past, particularly by the decision on the Iraq war or last year’s decision on military intervention in Syria. In the light of what has happened in recent months, will the Prime Minister consider seeking a new mandate from Parliament which begins not by ruling options out or by looking over our shoulders, but by exercising leadership and confronting the threat we face here and now?

David Cameron: I very much agree with the right hon. Gentleman that we of course need to learn the lessons of the past but must not be imprisoned by decisions that were taken in the past. I think the whole tone of the debate today is that, yes, it is for those in the region—principally the Iraqi Government and the Kurds and neighbours—to lead the charge against squeezing this appalling organisation ISIL, but Britain, America, France and others should use all the tools in our toolkit to help them to do that. We have to make a judgment about how we best help those on the ground, and to date that judgment has been to provide aid and political support and to help with certain military aspects. The Americans have gone further and provided air strikes. I think that is the right way to approach this problem.
	On the issue of control orders, let me quote again what the independent reviewer of terrorist legislation said:
	“There is no need to put the clock back. The majority of changes introduced by the TPIMs Act have civilised the control order system without making it less effective.”
	We have to understand that control orders were permanently being run ragged in the courts. We needed a new system and now we can improve it.

Crispin Blunt: Does the Prime Minister share Henry Kissinger’s analysis that to address the utterly appalling consequences of the collapse of central state authority in much of the middle east and north Africa, we are going to have to get competing nation
	states to co-operate? That means that Iran, Turkey, Saudi Arabia and Russia are going to have to be got in a place where they can co-operate with the United States and the European Union. It will involve ugly ethical compromises, which we have already made over Egypt. Will the Prime Minister set his Government the policy objective of getting those nations in the same place to have a policy that can begin to address this disaster?

David Cameron: I agree with what my hon. Friend says about the importance of getting nations that have not previously co-operated to co-operate with each other. I agree that we should get them to step up to the plate and do more to deal with the problems in their own area. However, as the former Labour Cabinet Minister, the right hon. Member for Wolverhampton South East (Mr McFadden), has just said, there are also times when we have to look to our responsibilities, and we should do that at the same time.

Keith Vaz: May I welcome the Prime Minister’s decision to place the Channel programme on a statutory footing, which is a long-standing recommendation of the Home Affairs Committee? He is right to focus on the obligation to return. The obligation to return resulted in Mohammed Ahmed Mohamed coming back from Somalia—he is now, of course, at large—and in Michael Adebolajo being brought back from Kenya, with tragic consequences. The details may therefore have to be worked out, but the principle of looking at this is extremely important. May I urge the Prime Minister to please make sure that there is engagement with the community itself on domestic terrorism—not just the mosques and organisations, but a direct approach to the communities?

David Cameron: I very much agree with both points made by the right hon. Gentleman. It has been very noticeable in recent days how many in the British Muslim communities have come forward to condemn ISIL in incredibly strong terms, and that is hugely welcome. I also take the point about the Home Affairs Committee recommendation about the Channel programme that we are putting in place.

Edward Leigh: If Islamic terrorism is the greatest threat we face, as we must all accept, surely our best policy is to maximise the coalition of the willing in the world, not to fight a two-front war. Given that Islamic terrorism is also an existential threat to the Russian state in Chechnya, does my right hon. Friend think there is a role for a British Prime Minister who is not parti pris in the ancient disputes in this area to try to broker a deal based on any move of Ukraine to the EU or NATO being balanced by similar moves to Russia and a federal solution for eastern Ukraine?

David Cameron: I do not agree with my hon. Friend about that. Where he is right is of course that Russia faces a threat from Islamist extremism, but so far I have seen insufficient evidence that it wants to work with international partners to follow that through in other theatres—most recently in Syria, where it is perfectly obvious to me that Assad’s brutality and the lack of support for the responsible opposition has
	helped foment the ISIL problem, which is something on which Vladimir Putin and I would take completely different sides.

George Howarth: Does the Prime Minister accept that young Muslims are increasingly radicalised not in the mosque or the madrassah, but online in their own bedrooms? I welcome his commitment to revisit the communications data legislation, but does he agree that we need to go even further with close international partners in bringing communications service providers to a realisation that they bear a responsibility for their platforms being used for illegal purposes?

David Cameron: The right hon. Gentleman is absolutely right about that. There is no doubt that a lot of radicalisation is taking place online—by people watching videos or watching preachers, or what have you—often on the other side of the world. We have worked very closely with internet service providers on the issue of child pornography, and they have agreed in that theatre, as it were, to take some pretty radical action, including banning altogether particular search terms. They are taking some action in terms of extremism and the material we are taking down, but I think that there is probably more we can do by working with them and saying, “This is not a threat to free speech, but it is appalling to have some of the videos that are now shown on the internet.”

Angela Watkinson: What recent discussions have the Prime Minister and his Ministers had with the leaders of mainstream Muslim organisations in this country to ensure that they are taking as robust a stance as possible in combating radicalisation and extremism?

David Cameron: I am grateful to my hon. Friend for asking that question. The Secretary of State for Communities and Local Government has taken a lead on that issue. Along with others and with the support of Members from all parts of the House, he has encouraged faith leaders of all faiths to condemn the outrages that we have seen. I think that the difference can be seen. The response of the community to the appalling murder of Drummer Lee Rigby spoke volumes about how the overwhelming majority of British Asians and British Muslims abhor such appalling behaviour.

Barry Sheerman: Is the Prime Minister aware that it would be inconceivable for us not to have an early debate on this subject, given the interest that has been shown in the House today? Perhaps next Monday would be an appropriate day. Is he also aware that much of the discontent among young Asians in my constituency is due to our perceived weakness over Gaza and our reluctance to distance ourselves from Israel?
	Will the Prime Minister think again about how we combat this dreadful bully from Russia? Our country’s history reminds us that if bullies are not faced up to, they continue to bully. If President Putin looks at our remarks and the remarks of the Prime Minister today, he will not exactly be terrified, will he?

David Cameron: On the issue of the debate, I am sure that the authorities will have listened to the hon. Gentleman and that we can find a way to have a proper debate, whether this week or next week. I am sure that that would be worth while.
	On Putin and Russia, as I have said before, what we have to do is to make the fact that Russia needs Europe and America more than Europe and America need Russia count. I am not promising that a set of sanctions will suddenly lead to a radical change of mind in the Kremlin, but if the Russians see that they are opting for a completely different and much, much colder relationship between the west and Russia, it might make them pause to think that they are making the wrong decision in not allowing the Ukrainians to make their own decisions about their own country.

Heather Wheeler: Does the Prime Minister agree that removing passports from terrorists who return from Syria and Iraq, barring dangerous foreign nationals from Britain and legislating to prosecute all types of terrorist activity are not a knee-jerk response, but a sensible and prudent approach to keep Britain safe?

David Cameron: I am grateful to my hon. Friend for her question. The first response should be to gather evidence, prosecute and convict. However, we have learned in this age of the appalling threat of Islamist extremist violence, which is different from some of the treats that we have faced in the past, not least because the people who carry it out not only do not care whether they survive, but seek what they see as martyrdom, that we have to up our response. We have lots of very effective laws and rules. We do not need to overhaul them, but we do, in some circumstances, need to enhance them.

Stewart Hosie: I welcome what the Prime Minister said, particularly about blocking foreign fighters entering the UK. However, as he pointed out, there have been 700 from France, 400 from Germany and hundreds more from other European and western countries, many of them travelling on EU passports. Is he confident that the data and intelligence sharing arrangements that are in place are comprehensive and robust, so that such people can be identified as they travel to the UK or to anywhere else?

David Cameron: The hon. Gentleman makes an extremely sensible point. The data sharing is good, but it could be a lot better. At the European Council, we looked specifically at the issue of passenger name records. The directive on that issue has so far been held up by a number of countries, including Germany. We need to make progress on that because the sharing of passenger names and records is vital in keeping us safe.

Angie Bray: I recently organised a meeting between local Somali community representatives and Home Office officials to discuss their deep concerns about the potential radicalisation of their young people. Does my right hon. Friend agree that more can and must be done to support, engage and work with local communities, such as the Somalis, so that they can be part of the battle against extremism? After all, they know their young people far better than anyone else.

David Cameron: My hon. Friend puts it very well. I believe that the cause of what we face is the cancer of Islamist extremism, but we should use everything that we have, including the many interventions that we make in the world, to help predominantly Muslim societies to demonstrate what a compassionate, tolerant, open and generous country Britain is. Britain has done a huge amount to help mend Somalia. Britain is one of the principal aid donors to people in Syria. We need to ensure that in all the communities of this country, those facts and figures and the outlook of successive British Governments are properly understood.

Ann Clwyd: A few weeks ago, the Prime Minister and the Government hosted an important conference on the sexual exploitation of women in war. Will he now tell me exactly what we are doing as far as the Yazidi women are concerned? More than 3,000 of them are being treated abominably by ISIS; they are being sold as sex slaves to the brothels of the middle east. What exactly are we doing to help those women? There was rightly a big public outcry over the 700 Nigerian schoolgirls, but what about the 3,000-plus Yazidi women who are being treated in that way? If they are released, they will find it very difficult to return to their own communities because of their experiences. Will the Prime Minister consider offering asylum to some of them, as France has done?

David Cameron: The right hon. Lady is absolutely right to raise the case of the Yazidi people, who are being persecuted by these dreadful, barbaric thugs from ISIL. We have helped directly by funding some of the refugee camps and making sure that they are properly built and prepared in northern Iraq. We were also prepared, over the summer, to take part if necessary in a huge humanitarian airlift operation, which was ready to go when those people were stuck on Mount Sinjar. Fundamentally, the best way to help the Yazidi people will be to ensure that there is an Iraqi Government who are able to confront ISIL and to restore to that country a sense that minorities are to be looked after and not persecuted.

Bob Russell: Today is the 50th anniversary of the establishment of the Royal Anglian Regiment. At that time, it had four regular battalions and three territorial ones. Now, it has only two regular battalions and just one reserve battalion. Does the Prime Minister accept that, in an increasingly dangerous world, both here and overseas, it is not in Britain’s defence interests to cut the size of the British Army to what it was at the time of Waterloo 200 years ago?

David Cameron: I do not agree with my hon. Friend, for this reason: it is in Britain’s interests to make sure that we spend our £33 billion defence budget on the assets that we actually need when facing the conflicts that we face today. So we have state-of-the-art Tornadoes that are able to fly over Iraq and Syria to gather intelligence, and we have brand-new Rivet Joint aircraft that can do similar things. The investment in those platforms, and in the brand-new class of submarines that are able to do similar things, is absolutely vital for our country. Yes, there are difficult decisions involved in
	changing the size and laydown of our armed forces, but unless we make those decisions, we will not have the assets that we need in conflicts such as these.

Paul Flynn: Will the Newport declaration that follows the Wales NATO summit contain strengthened guarantees to the other small nations of Estonia, Latvia and Lithuania, to protect them from Putin land grabs?

David Cameron: May I first say how delighted I am that the NATO conference is coming to Newport? I know that the hon. Gentleman and others in Newport will give the many different delegations and world leaders a warm welcome. One of the most important things at the NATO conference will be to send a clear signal that we take our article V obligations very seriously; all NATO members should be aware of that. As I said in answer to earlier questions, we should see more troops from the different nations in the countries of NATO to demonstrate that.

James Paice: I strongly welcome my right hon. Friend’s commitment to article V, but I am unclear as to whether he feels that that extends to the situation in Ukraine. I hear what he says about sanctions, but he will understand that many people question their value. Is it not therefore essential that NATO should make it absolutely clear to President Putin this weekend that Ukraine must not fall under his dominion, that this is down to the Ukrainian people and that NATO is prepared to ensure that this is the case?

David Cameron: I agree with my right hon. Friend that we should make it absolutely clear that it is unacceptable for Russia to behave in this way, but we should also be clear about how we are going to respond. I do not believe that we are contemplating—or would contemplate —a military response to the situation in Ukraine, so it would be wrong to threaten that. Instead, we should be threatening something that we can and, in my view, will do, which is to impose a permanent sanctions regime that gets tighter all the time if Russia continues down this path. That would totally reset the relationship that Russia has with the rest of the world.

Richard Burden: I agree with the Prime Minister that it is important that our responses to international crises should be based on clear values. May I invite him to agree with me that those values should be applied consistently? He said that the biggest land grab in the west bank in the past 30 years is “utterly deplorable”, and I agree with him. He also said that what appears to be a land grab by President Putin in Ukraine must be met with “economic costs” on Russia being “stepped up”. He said that sanctions work, which is particularly important when a small nation is threatened or undermined by a more powerful one. May I invite him to apply that same logic to Israel’s actions in the west bank?

David Cameron: We can draw these parallels, but of course there are differences between the circumstances of Israel and Palestine and what is happening in Ukraine, not least because Ukraine is an independent, sovereign,
	recognised country today. But I do think we should make very clear our reaction to this totally unacceptable land grab by Israel.

Jason McCartney: Having served in Operation Warden in the 1990s—the no-fly zone over northern Iraq—and having met Kurdish students at Huddersfield university during the summer, I support targeted air strikes by the UK to support the US in checking the advance of the evil ISIL. Will the Prime Minister take account of the comments of those Kurdish students that the UK taking part in those air strikes would be not only militarily expedient but symbolic of our support for the Kurdish people?

David Cameron: I think we should listen very carefully to our Kurdish friends and allies, because they are in the front line against this ISIL monster. The action that they have taken has been effective and brave, and we support the air strikes that the Americans have undertaken. So far, our action has been about supplying them with weapons, support, non-lethal equipment, body armour and suchlike, and as I have said, we are prepared to go further.

Mike Gapes: The Prime Minister talked about learning the lessons of history. A previous Conservative Prime Minister, 23 years ago, was prepared to use British air power in a military exercise to save the Kurds. Why should we just leave it to the United States, particularly when the Kurdistan regional government have called for the whole of NATO to express solidarity and provide weaponry to them and air power to fight this genocidal caliphate?

David Cameron: The hon. Gentleman makes a good point. As I have said, the question we should be asking ourselves in this House—I am interested in the reactions of colleagues today—is what we can best do to help those on the ground who are doing the vital work in combating ISIL. Up to now our approach has been some military support, some support through intelligence and weaponry and some support through humanitarian aid, but we should continually ask ourselves how we can assist them in a way that also helps to keep us safe back here in the UK.

Steven Baker: I was appalled to learn that the British terrorist interviewed on “Newsnight” came from Wycombe. Does my right hon. Friend agree that this man has disgracefully betrayed the community that I represent? Given what was said, can he reassure me that if that man presents in the UK, he will face the full force of the law?

David Cameron: I very much agree with what my hon. Friend says. This individual is in no way representative of the many hard-working British Asians who live in his constituency and contribute enormously to our country. It is shocking to read someone born and raised in Britain, and schooled in our country, saying, “The only reason I want to come back to Britain is to bomb, maim and kill”. Of course we should ensure that we have laws—we do have such laws—so that people who say and do these things can be prosecuted, but the reason
	for asking what more is required is that sometimes, these cases do not come up to a level of criminal proof, yet these people threaten our country. That is why there were control orders in the past and there are now terrorism prevention and investigation measures, and that is why we are taking steps to strip people of passports or prevent people from coming into our country. Where there are gaps, it is worth asking whether they can be addressed.

John Woodcock: The Prime Minister’s responses to previous questions imply that he is open to the idea of direct military participation in the current air strikes to protect the Kurds. If that is the case, will he just say so clearly now?

David Cameron: I have described the approach we have taken to date, and said that we support American air strikes. I do not think that we should rule anything out. We should act, and a British Government should act, to promote the British national interest and to help keep our people safe. We should consider everything in the light of that. In particular, as I have said, we should ask ourselves how we best help those people on the ground who are doing vital work in countering ISIL. On these issues, I always believe that it is vital to consult, talk with and listen to the House of Commons at every stage.
	The House will be reassured to know, however, that if there was a direct threat to British national interests, or if, as in the case of Libya, we had to act very rapidly to prevent a humanitarian catastrophe, the British Government must reserve the right to act immediately and inform the House of Commons afterwards. It is important to set that out, but the House has seen what the British Government have done to date, and I am listening carefully to the views of hon. Members in this debate.

Bob Stewart: Tragically, the only way to defeat people who are determined to carry out appalling acts, despite reason, politics, economic sanctions or whatever, is to defeat them on the battlefield. The only way that can be done against ISIS is for someone to go in there and do it. It does not look as if it will be us or the Americans, and it will probably not be the Kurds; the people who seem most likely to be able to do it are the Iraqi Government and their armed forces. Despite it being somewhat distasteful, can we give as much support as possible to the Iraqi armed forces so that they can do the job that no one else seems able to do?

David Cameron: My hon. Friend is fundamentally right that, at the end of the day, responsibility for a unified Iraq without the presence of ISIL, and without this extremism and terrorism, is with the Iraqi Government. To do that, an Iraqi Government is needed that includes Sunni, Shi’a and Kurd. We should not see support for the Kurds and support for the Iraqi Government as alternatives. To get rid of the cancer in their midst, we need an Iraqi Government who work with the Kurds.

Grahame Morris: The Prime Minister has set out his arguments for the withdrawal of UK passports. Given the strong evidence of Israeli war crimes in Gaza—we have heard about 500 children
	being killed under a terrible bombardment—will British citizens fighting in the Israel defence forces be treated in the same way as those returning from Syria and Iraq?

David Cameron: I really do not think that is a fair or reasonable way of describing the situation. As I said, the loss of civilian life was unacceptable, and it is right that these matters are properly investigated. We must remember, however, that the conflict was started by Hamas rockets raining down on Israel, and Israel has a right to defend itself. I think that the hon. Gentleman, when he looks at his words, will come to regret drawing a comparison between a soldier fighting in the Israel defence forces and a terrorist returning from Syria.

Philip Hollobone: In the 50-day conflict between Israel and Hamas, 70% of the Israeli population lived within range of the 4,500 rockets fired from Gaza, and 2,000 Palestinians were killed in response. Given that Britain is one of the biggest donors to the United Nations Relief and Works Agency in the Gaza strip, will the Prime Minister work with others such as the United States, Egypt and the Arab League, to demilitarise the Gaza strip so that construction materials and steel can be imported into it and used to rebuild the civilian infrastructure, rather than being ploughed by Hamas into developing a new terror tunnel network?

David Cameron: I very much agree with my hon. Friend. In short, we need to see the rockets out, the Palestinian Authority in, and the borders and posts open so that that part of Palestine can be properly regenerated.

Sammy Wilson: Many of the controls being proposed will be effective only if they also apply to the Republic of Ireland, because of course people could enter the United Kingdom by coming in through ports of entry in the Republic of Ireland and across the land boundary into Northern Ireland. What discussions has the Prime Minister had with the Government of the Irish Republic on the proposals? Is it intended that intelligence will be shared with the authorities in the Republic, or will the proposals apply only to ports of entry in Great Britain, hence creating travel restrictions between Northern Ireland and the rest of the United Kingdom?

David Cameron: The hon. Gentleman makes an important point. The relationship, including on policing, security and borders, between the British and Irish Governments is probably stronger than it has been for many years, and we should build on that by discussing these measures with them and working together.

Matthew Offord: On three different occasions and in three separate locations, weapons and rockets belonging to Hamas were found in UNRWA schools in Gaza. Given that siting missiles and rockets amid a civilian population is a war crime in itself and will inevitably lead to the loss of civilian lives, and given that lobbing those same rockets into Israel, killing other civilians, is also a war crime, does the Prime Minister agree that Hamas is now guilty of two war crimes?

David Cameron: There can be little doubt that Hamas uses people to try and protect its rockets, which is absolutely despicable. As I have said, we need an end to the rocket attacks, a continuation of the ceasefire and political talks that could lead to a better solution.

Michael McCann: Will the Prime Minister condemn Hamas for violating and rejecting 11 ceasefires? If those ceasefires had taken place, the deaths of hundreds, and potentially thousands, of people could have been prevented. Does he agree that the only way to secure peace between the Israelis and Palestinians is first to ensure that Hamas accepts Israel’s right to exist?

David Cameron: The hon. Gentleman is absolutely right. On several occasions during this conflict, a ceasefire was either agreed or implemented, but Hamas broke it with unilateral rocket attacks into Israel. These were attacks directed, we believe, by the leader of Hamas, who of course was nowhere near Gaza at the time. I believe that Hamas bears primary responsibility for what has happened.

Mark Pritchard: I welcome the fact that the Prime Minister has not ruled out air strikes against ISIL positions, but may I ask him what needs to happen that has not happened thus far before he approves such targeted air strikes with the Americans?

David Cameron: So far, the Americans have been leading on the air strikes and have not requested assistance from us, while we have been focused on those areas—aid, diplomacy, military assistance to some of the parties—where we can most add value, but, as I say, we should continually ask ourselves: what is in the national interest, how can we best help those on the ground and how can we not just work with our partners such as America, but help ensure that the Iraqi Government, the Kurdish Regional Government and neighbouring countries take the lead, rather than the west feeling it has to impose a solution.

Gerry Sutcliffe: I was the Opposition spokesperson on the Terrorism Prevention and Investigation Measures Bill. The Government’s two principal objections to control orders concerned the use of exclusion zones and relocation powers—the two things the Prime Minister now says that the security bodies need. To be fair to him, the deal on TPIMs was a sop to the Liberal Democrats, but will he ensure that the security bodies get the powers they require?

David Cameron: Although the hon. Gentleman clearly spent a lot of time on the Bill, he seems to have ignored one crucial point, which is that TPIMs include exclusion zones; I think it is the relocation powers he is referring to.

Henry Smith: I commend the Prime Minister on his statement. Will he give a little more information on when airlines will be required to introduce more stringent checks on suspects and foreign terrorists to block them from entering ports such as Gatwick and others around the UK?

David Cameron: I can quite understand, given my hon. Friend’s constituency interest, why he asks this question. At the moment, we have good security co-operation, but on a non-statutory basis, with countries flying into the UK. These measures will put it on a statutory basis that if they do not have proper passenger checks, share information in a timely way or have proper security checks, we can legally prevent a plane
	from taking off from or landing in the UK. These are the sorts of arrangements that the Americans already have in place. It is time for us to have them too.

Mark Hendrick: Russia is invading Ukraine by stealth. I accept that EU sanctions will bite in the mid term and longer term, but in the meantime Putin is quite happy to let his troops carry on and take eastern Ukraine. Will the Prime Minister look seriously at arming the Ukrainians, because otherwise the state will not exist as we know it today?

David Cameron: As I said, I think what is required is a military de-escalation, rather than a military escalation. What we saw, if we go back over recent weeks, was huge advances by the Ukrainian military, almost closing out the rebels from some of the cities in eastern Ukraine, and now we have seen this military response. That only goes to demonstrate that more military assets being provided in either case will simply lead to an escalation, rather than what is required, which is a proper political discussion about how to have a permanent ceasefire and a peaceful resolution that allows the Ukrainian people to make their own choices.

David Nuttall: Church leaders and others in my constituency have raised with me the plight of the Christian Church in many parts of the middle east. Will the Prime Minister reassure them that the Government are doing all that can be done to help those persecuted Christians?

David Cameron: My hon. Friend makes an important point. We should of course ensure that we protect Christians, but we should also ensure that we protect other minorities. The Yazidi people—where we were prepared to undertake a substantial airlift operation—is a case in point. This is absolutely at the heart of our foreign policy—protecting minorities, protecting religious freedom and protecting the rights of Christians and others to practise their faiths.

Jamie Reed: The Prime Minister is absolutely right: de-radicalisation is critical, but so too is community cohesion. What specific proposals does he have to ensure that no community in our country feels that it is being marginalised or brutalised, or under attack or constant suspicion?

David Cameron: The hon. Gentleman puts it well. We need to be intolerant of intolerance and very clear that supporting extremism that falls short of violence, as well as supporting violence, is not acceptable. At the same time, we need to take people with us, because among the most effective groups, organisations and people are those from Muslim communities themselves who want to confront the problems—perhaps in a local mosque or a community centre, but more commonly online or in other forums. We need them to help us do this job.

John Leech: A number of innocent British nationals of Syrian descent have already faced problems, including frozen and closed bank accounts, when returning from supporting
	humanitarian efforts in and around Syria. How will the Prime Minister ensure that innocent British nationals returning to the UK are not labelled as suspected terrorists?

David Cameron: My hon. Friend makes an important point, but I have to say that I think the first piece of advice we should give to any British national thinking of travelling to Syria to help on a humanitarian basis is that there is an enormous amount of good humanitarian work being done that they can help to support and fund without leaving the United Kingdom. I think that should be the first port of call. Obviously, in terms of returnees, we need to make sure that what we do is targeted at those who are intent on causing trouble.

Madeleine Moon: Murder, rape and abduction have been used against women in Iraq by ISIS and across Syria. Britain hosted a conference on ending sexual violence against women. We have also signed UN resolution 1325. What women need is a place at the table when discussions take place about peace and the resolution of conflict. Will the Prime Minister commit to ensuring that Britain does its utmost to make sure that women have a place at the conference table, that women are represented and that women are part of the British delegation to the UN conference in Newport?

David Cameron: Leading the delegation from Britain will be the former Foreign Secretary, my right hon. Friend the Member for Richmond (Yorks) (Mr Hague), who has probably done more than anyone else to put this whole agenda on the table, not just by raising its profile but, as the hon. Lady says, making sure there are actual measures that can be taken, in terms of prosecuting those responsible and keeping proper records of what is now a war crime. She is right about the other points that she makes.

Jonathan Djanogly: Will my right hon. Friend please confirm the exact steps that Russia needs to take over the next week in order to avoid further sanctions? If sanctions are required, will he please confirm that they will be tough and substantial and that Mr Putin will notice this time?

David Cameron: The steps that need to be taken are to stop supporting the separatists in eastern Ukraine with men and material, and also to release hostages and get out of the border posts that are part of Ukraine’s sovereign territory. Those steps, I think, would signal a change of heart from Russia and would result in an easing rather than a growing of the pressure. I do not accept that what has been done so far has not been noticed, but we have to show resolve in permanently turning up the dial if Russia continues in the wrong direction.

Fiona Mactaggart: The Prime Minister knows—indeed, he has acknowledged in response to my hon. Friends—that young Muslims at risk of radicalisation are more likely to listen to peers and people in their own community than they are to police officers or representatives of the Government who they believe has failed to protect the people of Gaza. Why, then, has he cut £15 million from the Prevent communities budget and will he take the opportunity today to say
	that he will put that money back into that sort of voluntary community-based action that will persuade these young people away from radicalisation?

David Cameron: We do work through Muslim and other organisations, and we should do so. We did make changes to Prevent, not least because, when we reviewed it, we believed that some of the funded organisations were not confronting the problems of extremism. That needed to change.

James Wharton: I was in Kiev on Saturday and heard at first hand about some of the challenges that Ukraine faces. Villagers there are banding together to buy body armour and helmets for soldiers going east. I ask the Prime Minister to look again at whether we can supply equipment to the Government of Ukraine and, specifically and urgently, to look at what we can do to help by sharing military intelligence data, which I am told is so badly needed in the fight for democracy on Europe’s borders.

David Cameron: Let me reassure my hon. Friend, who makes a very good point—I am glad that he was able to travel to Kiev to listen to the views of people there—that we are supplying non-lethal equipment. Body armour and things like that will help the Ukrainian army, and I think it is right to give those things, but as I said and for the reasons I gave, I do not think we should supply it with arms.

Khalid Mahmood: Instead of having an intimate weekend meeting with the Deputy Prime Minister, who I see is not in his place, would it not have been more productive for the Prime Minister to see the Home Secretary and speak to her about replacing the lost passport control officers’ jobs and to work with the security services to ensure that they have control over those leaving and returning, which would enable us to gather real intelligence about what is going on and how we can stop some of the radicalisation that is taking place?

David Cameron: Let me first reassure the hon. Gentleman that I had a very good meeting with the Home Secretary on Friday, when we discussed these issues. On checks for those applying for passports, there has not been a reduction in the level of scrutiny. In all these organisations, of course, we have to seek efficiency and make sure that we use all the modern technology to get the job done.

Michael Ellis: If at some date in the future my right hon. Friend were minded to engage in military action—punitive military action—against what we know to be the mediaeval barbarism of ISIL, would he be minded to consult this House?

David Cameron: I always believe in consulting this House. I did so over Syria and over Libya. What I—as well as the Foreign Secretary and Defence Secretary—will try to do is to keep the House permanently updated. As I said in answer to a previous question, that is the right approach and it has been taken by successive Governments. If, however, something needed to be done urgently to protect a particular British
	national interest or to prevent some humanitarian catastrophe, it might be necessary to act and then come to Parliament. I have said nothing new in that, but it is important for people to understand the situations we face.

Susan Elan Jones: I very much welcome what the Prime Minister said about the importance of tackling the extremist narrative. Is he aware, however, that his parliamentary candidate in Dudley North told The Independent on Sunday:
	“Jihadist narrative answers the questions that these young people ask”,
	and that
	“IS provides an opportunity to do something real, exciting and spiritually nourishing.”?
	Those comments are preposterous; what does the Prime Minister propose to do about them?

David Cameron: I will check the context of those comments, as I expect the candidate went on to say how wrong that is, which I know is his view. It is unreasonable to cite what I suspect is a partial quote rather than the whole thing.

Rehman Chishti: On tackling extremism and radicalisation, I welcome the fact that more than 1,000 individuals have been diverted from entering extremism and jihadism through the Government Channel programme. As someone from the Muslim community whose father was an imam, I would like to ask what further steps the Government are taking to engage with the Muslim community to tackle the evil of radicalisation and extremism affecting some young Muslim men in our society. Linked to that, I note that the extremism taskforce has made its recommendations. Will the Government be appointing a specific individual to monitor the implementation of those recommendations across Government Departments and to recommend further specific action?

David Cameron: On my hon. Friend’s latter point, the extremism taskforce came up with a number of recommendations, most of which have been put in place or are being put in place. They concern banning hate preachers and ensuring that we confront extremism and root it out at places such as universities and, I am ashamed to say, our prisons, where there have been problems. On his questions about what more we can do, the Channel programme is successful. There is a programme of engagement to divert young people from this cancerous organisation. As I said earlier, one element of that is to demonstrate some of the things that the British Government do throughout the world to support minorities, stand up for human rights and help Muslims in a variety of ways in a variety of countries.

David Anderson: At the end of this summer we are seeing relations between the west and Russia at their worst level for three decades, 2,000 innocent people killed in Gaza and genocide in Kurdistan. The Prime Minister said this is the most serious threat that we have ever faced, yet he chose not to recall Parliament. Can he explain why he thought we should not have our say in a proper debate so that hon. Members on both sides of the House could make their comments? Last year, it was decided within 48 hours to
	recall the House to pay tribute to Margaret Thatcher, who presided over a Government who watched Saddam Hussein kill innocent Iraqis by the thousands.

David Cameron: Last year we recalled Parliament because there was a particular issue that needed to be addressed: the role that Britain would or would not play in combating the use of chemical weapons in Syria. This year I do not think that it was necessary to recall Parliament. To have done so at certain stages might have almost shown that somehow we were reacting to individual terrorist events, ghastly as they were. Now Parliament is back, there is plenty of opportunity to ask questions and have debates.

Robert Halfon: I thank my right hon. Friend for his statement that Israel was right to defend itself against the missile barrage from Hamas. Does he agree that the difference between Hamas and ISIS is one of degrees? Does he also agree that Iran remains a serious security threat and that our enemy’s enemy is not our friend?

David Cameron: My hon. Friend makes an important point. If one saw the shocking pictures of Hamas lining people up and shooting them in a firing squad, one could see the nature of the organisation with which one is dealing. It is an important issue. I support a Palestinian state. I want the Palestinians to achieve that goal, but Hamas is a terrorist organisation. It believes in targeting innocent people and murdering them to pursue its objectives. It does not even recognise the right of the state of Israel to exist. Therefore, we have to start our discussions with a recognition of the true nature of the organisation that we are dealing with. He is right about that.

Toby Perkins: People throughout Britain have been absolutely appalled by the scenes in Gaza, Iraq and Syria this summer. What impact have all the Foreign Office resignations and the removal of the Foreign Secretary, at an incredibly difficult time for the Foreign Office, had on the British Government’s capacity to respond?

David Cameron: The new Foreign Secretary has had a full in-tray but he has handled these issues and discussions with huge calmness and ability. People have seen that over the summer. Obviously, it is a matter of regret that Baroness Warsi decided to resign. On the other change in the Foreign Office, we have a new Minister for Africa, who I know will bring a lot to that job. Overall, we have a very strong team of Ministers who are more than capable of tackling these issues.

Richard Drax: Thank you, Mr Speaker. I apologise for leaving the Chamber; I had to go to a statutory instrument Committee. I heard a question earlier about how much money we are spending on defence. Will the Prime Minister consider, bearing in mind what is going on in the world, that 2% is simply not enough?

Mr Speaker: Order. It is very candid of the hon. Gentleman to inform me, and some hundreds of other people, that he absented himself from the Chamber for a period. It was a fact of which I was unaware, but full marks for 100% candour.

David Cameron: I think it is important that we meet the 2% figure. Greece is the only other European member state to meet that figure. What matters even more than that is the capability of what we are buying. We have made some very difficult decisions, including the reduction in the size of the regular Army, but that is so that we can invest in the modern equipment and modern capabilities that our armed forces need. When we consider that it is one of the top five military budgets anywhere in the world, with some staggeringly good equipment being produced even as we speak, I think that we get very good value for money.

Andrew McDonald: Over and above the Prime Minister’s very welcome words of condemnation regarding the annexation of yet more lands around Bethlehem, what practical steps does he intend to take so that Israel reverses this latest, and counter-productive, land grab and commits properly to a two-state solution?

David Cameron: We will continue to work with our allies to condemn this action and to make that clear in international forums. We will continue with our action to support and fund the Palestinian Authority. But at the end of the day, we need talks between the Palestinians and the Israelis. We cannot decide these issues for them; they need to sit down and talk with each other.

Richard Graham: The Prime Minister rightly said that ISIL activities are deplored by the vast majority of British Muslims, but, none the less, various events and reports this summer have led to a growing unease about the role of Islam in our country. The battle that is harder than the one for air supremacy on the Iraqi border is therefore the one for community cohesion here in the UK. I believe the time has come for a charter, which would be a public commitment by community and faith leaders, especially including mosque committees, against extremism and for our values to help to prevent citizens from acting against our country. This could be done locally—I would happily lead on it Gloucester—but does my right hon. Friend agree that a single national charter implemented across the country could have the real benefit of bringing our communities together, which is our best defence against extremism of all kinds?

David Cameron: I think my hon. Friend makes an interesting suggestion. I would say that these initiatives have far greater power if they are generated by the communities themselves. It has been noticeable how many leaders of Britain’s Muslim communities—mosques, community groups and others—have come out and condemned what ISIL stands for and the other things that we have seen. So if there was going to be such a charter, I would want to see it generated from within that community rather than imposed on it.

Nia Griffith: The Prime Minister has made very brief reference to the sanctions against Russia. Will he give us more detail on what additional sanctions he pushed for and what additional sanctions have been agreed by the EU states?

David Cameron: What I pushed for was further so-called tier 3 sanctions, which are real economic sanctions in the areas of finance, energy and defence. We have tasked the European Commission, within a week, to come up with a set of new proposals. What I pushed for specifically was to make sure that we start filling in some of the gaps that have been left in previous financial energy and defence sanctions. I mentioned the case of syndicated loans, where the action that has been taken on the financial front has seen the Russian stock market fall and the rouble fall, and Russia’s growth rate has now been downgraded to, I think, zero or below. So further measures on that level—which will affect Britain, but we should be prepared to take that pain—would be good.

David Burrowes: The Prime Minister spoke of a humanitarian catastrophe prompting further military action, so how would he describe what has happened to the Syrian Christians and the Yazidis facing genocide? How much worse can it get for mothers who have been forced to throw their children off a mountainside rather than have them suffer at the hands of jihadists—suffer a fate worse than death? Will he justify why we are not using all necessary military action, including air strikes, to repel genocide?

David Cameron: Let me take, for instance, the case of the Yazidi people, where there was military action by the Kurds, supported by us, and, indeed, some military action contemplated by the Americans that would have been supported, and potentially facilitated, by us. Of course, the role we were prepared to play was to take part in a humanitarian evacuation. That would have involved British transport planes and helicopters and, indeed, British troops in the Kurdish areas of Iraq to support, maintain and look after those helicopters. So I do not accept that we will not intervene where there is a potential humanitarian crisis; we would, we will, we have in the past, but we should, as I say, ask ourselves the question, “What is in our national interest, what is the best way to proceed?”

Kate Green: The suffering of the Palestinians in Gaza, not just in this most recent conflict but over many years, continues to be a source of great distress and concern in my constituency, and this latest land grab will of course have further infected the situation. What recent—very recent—discussions has the Prime Minister had with the Americans in relation to this matter, since it is widely perceived that any lasting solution will depend on their influence with Israel and there is real concern that, with so many other international conflicts, their eye, and our eye, may be taken off the ball in Gaza as we deal with other threats?

David Cameron: I did discuss this issue with President Obama when we spoke during August, and to be fair to him he has taken a tough line over the need for a ceasefire and was very clear with the Israeli Prime Minister, as was I, about the need for a ceasefire and about the frankly unacceptable level of civilian casualties. Now we have the ceasefire, it should be about trying to get Gaza up and running again. That means the Palestinian Authority taking control, the rockets being taken out and the important restrictions being lifted so that that place can function properly.

Jeremy Lefroy: The people of Jordan and Lebanon have shown immense hospitality to refugees from Syria and elsewhere and yet are under incredible pressure from the crimes perpetrated by President Assad, ISIL and others in that region. What support is the United Kingdom Government giving to those two countries which find themselves in this position?

David Cameron: Perhaps the best assistance we can give, which we have been giving, is assistance with their humanitarian aid programmes for the refugees who are inside the borders of Lebanon and Jordan, and I have seen some of that work at first hand. We should also continue to think about what else we can do, in terms not just of humanitarian aid, but also political, diplomatic and even potentially some military support, to help those countries.

Andrew Gwynne: On the deteriorating situation in Ukraine, can the Prime Minister set out what he believes to be achievable at the meeting of the contact group that is taking place in Belarus literally as we speak? Will he also set out to the House some of the actions he will be prepared to countenance— we have heard plenty of what he is not prepared to countenance—should there not be adequate progress towards a ceasefire?

David Cameron: First, in terms of what Britain has been prepared to do, I would say that at the last few European Councils Britain has been perhaps the leading voice for taking tough sanctions measures. That has been something Donald Tusk, the Polish Prime Minister, and I have worked on very closely with our colleagues from the Baltic states. Britain, which frankly has quite a lot to lose in terms of financial services, has been at the absolute front end of arguing for those changes, of which I am proud, and we will continue to do that. In terms of the steps that need to be taken, President Poroshenko has set out a peace plan that involves respecting the rights of Russians and other minorities, and what we need is for the Russians to go along with that peace plan and to start to de-escalate the situation.

Stephen Metcalfe: Will my right hon. Friend tell the House how far he and the Government are willing to go to protect the Christians in northern Iraq, as there are many who believe that the very existence of Christianity in the middle east is under threat?

David Cameron: With others, we should be working to protect these minorities, including the Christians in northern Iraq, and I set out to my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) the sort of steps we would be prepared to contemplate. We should not rule out future measures; we should use all those things that we have at our disposal, while recognising that there is not some unique military solution that can be put in place.

Paul Blomfield: On a number of occasions this afternoon the Prime Minister has repeated his welcome condemnation of the Israeli appropriation of Palestinian land, but does he
	recognise that over many years words alone have failed to move the Israeli policy of illegal occupation and that now is the time for concerted action to force the Israeli Government to shift their policy?

David Cameron: To be fair, the reason I have repeated myself is that I have been on my feet for about two hours so there is bound to be some repetition—and even hesitation and deviation at moments. The point I make is that we have in the past been prepared to back up our actions, as we did with other EU partners over the issue of research grants to Israel. However, as I said, the first step is to make absolutely clear our condemnation of this, and I will work with others to make sure it is reversed.

Paul Uppal: One reason why so many young people of a south Asian heritage, be they men or women, are put on the conveyor belt towards extremism is that they often have the baggage of a dual cultural heritage. I have been on this journey so I know that the pressures placed on them by extended family and their own community groups are acute and powerful, but within the vacuum there is often a lack of British identity. May I impress on my right hon. Friend the fact that it is crucial we have a debate that propagates the view that someone can have a traditional view of Islam, which stresses justice, faith and truth, but within that they can essentially be British, and that to do that in a pragmatic way is quintessentially British?

David Cameron: My hon. Friend has put it extremely well. It is perfectly possible for people to come to this country and integrate in our way of life while maintaining their own religion and faith and the traditions that go with them. Over the years, Muslims, Hindus and Jews have all managed to do that in Britain, but perhaps we need to do more to help it to happen. That is where the debate goes into how we teach in schools, how we try to integrate communities and how we promote the use of English. All those things are important steps on that journey.

Debbie Abrahams: Four weeks ago, I led a multi-faith delegation from Oldham in presenting a petition to the Prime Minister asking for Parliament to be recalled in order to have a debate on how we can support sustainable peace in Gaza and Israel. Two weeks later, I wrote asking what progress had been made on the recall and whether we could also debate the ongoing crisis in Iraq. I am not still clear why the Prime Minister decided not to recall Parliament, as surely these matters deserved our attention during recess.

David Cameron: I always look at the arguments people make for the recall of Parliament and think about it carefully. What I said while Parliament was in recess was that I did not rule it out and we should keep it under review, but I did not think it was necessary, because there was not a specific decision that Parliament was being asked to make. It is good that we are now back and we can debate these issues.

Rob Wilson: I welcome the ramping up of sanctions by the European Union, but does the Prime Minister agree that what is happening in Ukraine is naked Russian aggression? Is it not time for the west, led by NATO and the US, to honour its obligations to Ukraine and face down this threat?

David Cameron: I absolutely agree with my hon. Friend that it is relatively clear what is happening: Russian troops with Russian equipment are on Ukrainian soil. The evidence for that now is overwhelming, and I think our response should be very clear about how unacceptable that is. We should be making use of the great strength we have, which is that Russia needs America and Europe more than America and Europe need Russia. We need to make that relationship pay and play so that the Russians change their approach, but it will not be an easy step to take. I do not think it would be right to try to find some military response to this, but if we make our influence and our power felt, Russia will see the consequences.

Ian Paisley Jnr: Those of us who have lived under the actual activity of terrorism for most of our adult lives will welcome any statement or action by this Government, or indeed any Government, to protect citizens, our citizenship and our land and property. I therefore welcome the steps that have been outlined today by the Prime Minister, but could he go further? If a person arrives at a British port internally with their passport and the officer decides to hold that passport, will the individual also be detained? If not, would the Prime Minister consider detaining those heading to the airport who are going to have their passports seized or those returning, in an internment-like situation?

David Cameron: The point of taking away the passport at the border post as we are proposing is that we are then able to investigate the individual and to give ourselves some time to do that, but I will look at the other suggestions that the hon. Gentleman makes.

Julian Huppert: The Prime Minister presented two options for terrorism prevention and investigation measures. May I strongly urge him not to go down the route of internal exile without trial, which is not consistent with the British values we are trying to defend, but to make use of exclusion measures that are already in the legislation?

David Cameron: Of course I listen carefully to the hon. Gentleman, but I also listen carefully to the police, the intelligence services and those who work around the clock to keep us safe. Their point of view is not that we need some wide-ranging piece of legislation, but that they have identified some specific problems that need to be dealt with. My responsibility as Prime Minister whose most important task is to do everything possible to keep our people safe is to listen to them, to bring the ideas based on those concerns to this Parliament, to debate them and then to put them in place.

Mark Durkan: The Prime Minister has stressed the need to counter the extremist narrative. Clearly, he recognises that there are those who are
	sowing alienation, radicalisation, extremism and subversion, but does he also recognise the danger of helping to fertilise what they are trying to propagate? I am talking about when Governments appear to adopt double standards and inconsistency in relation to clear violations of international law, not least in respect of Gaza, and then in domestic law appear to create a twilight zone around the very basic concept of citizenship.

David Cameron: I do not accept that we are operating any sort of double standards. I have set out the situation very clearly with respect to Israel and Gaza, and also the problems that we face with ISIL. It will be for hon. Members to decide whether or not they want to support that.

Points of Order

Jesse Norman: On a point of order, Mr Speaker. I welcome the remarks that you made in your statement earlier about the need for a pause for consultation and for good will and consensus on the appointment of Ms Carol Mills. Do you agree that, at least as regards the procedural and constitutional aspects of the Clerkship, she is not qualified for the role? If so, is it your intention to withdraw the letter of recommendation, at least for the period of the pause and consultation?

Mr Speaker: I thank the hon. Gentleman for his point of order and the terms in which he expressed it. I say to him that it is not for me to withdraw a name. A decision was reached by a panel. I hope that hon. and right hon. Members will accept that it would not be seemly to comment on the characteristics of, or performance by, individuals participating in a still ongoing process. I referred to the need for a pause and I meant it. I talked about hearing the views of colleagues and I meant it. I also talked about the need to proceed with good will and by consensus. I stand by that and I hope that is regarded as helpful.

Peter Hain: Further to that point of order, Mr Speaker. Will you advise me and Members of this House how we can support your proposal to separate the functions of the Clerk of the House and the chief executive? I came to the view when I was Leader of the House in 2003-05 that that was essential. The Clerk needs to be an experienced and specialist expert in parliamentary procedure. The chief executive, however, has a different function. Managing a £200 million budget and 1,500 staff requires very different skills. As Leader of the House at a time of serious security breaches, I recall having to overcome serious resistance among vested interests and fiefdoms in this House, some of which are still here, against the appointment of an independent, professional head of security. Nobody today thinks that that was anything other than absolutely necessary. I urge you, Mr Speaker, to stick to your guns on this separation of the functions.

Mr Speaker: I am grateful to the right hon. Gentleman who speaks with the experience of a former Leader of the House. People can express their views on the Floor of the Chamber, in letters to me or to the Leader of the House or the shadow Leader of the House or in the form of one-to-one conversations. I want to hear what people have to say. The right hon. Gentleman has started that process, but it is open to others to continue it. Let me repeat that I wish to hear all views from all Members from all parts of the House.

Alan Duncan: Further to that point of order, Mr Speaker. Will you confirm that the advisory panel constituted for the purposes of this appointment is now defunct and that inasmuch as you intend to go back to the House and its representatives, you will do so only to the House of Commons Commission?

Mr Speaker: I am grateful to the right hon. Gentleman for that point of order. I do not know whether it is technically correct to say that the panel is, as he puts it,
	defunct, but I offer him the assurance I think he seeks that of course matters must proceed by reference to the House of Commons Commission, which meets on Monday 8 September and on the agenda of which there is, of course, an update on this matter.

Keith Vaz: Further to that point of order, Mr Speaker. I join other colleagues in welcoming what you said at the start of the sitting today. Do you envisage this pause lasting any particular period of time, and will it include any examination of the candidates by the relevant Select Committee?

Mr Speaker: I am grateful to the right hon. Gentleman. I think that it is sensible to proceed in a timely way and that is why I referred to a modest pause although, of course, I am in the hands of and ready to be guided by the House. With reference to the possibility of pre-appointment scrutiny, to which, I think, the right hon. Gentleman refers, if that is what the House wants that is what the House should have, a point that I think I conveyed with a modicum of clarity in my statement earlier this afternoon.

Andrew Lansley: Further to that point of order, Mr Speaker. The efficient conduct of House business requires the House to know to whom the House service is accountable at any given time. Will you confirm to the House—I hope you will—that when there is a vacancy for the office of the Clerk the Clerk Assistant leads the House service for this purpose and, under the Parliamentary Corporate Bodies Act 1992, may exercise the functions of corporate officer and accounting officer for these purposes and is therefore both the leader of the service and the corporate officer for the time being?

Mr Speaker: The short answer is yes. The right hon. Gentleman is a wily enough hand to know that it is a good idea to be aware of the answer to a question before posing it. He has proved that he meets that test.

Hazel Blears: Further to that point of order, Mr Speaker. Clearly, the House has changed even during the 16 or 17 years I have been a Member and it is now a complex and in many ways a very professional organisation that has responsibilities for human resources, corporate finance and a series of other issues that might not have been so important 20, 30 or 40 years ago. Many of the changes you have overseen with colleagues on the House of Commons Commission have made this place more efficient and more professional in my view, but it is important when we are appointing a person of such seniority in this House that we should take a very clear look at the responsibilities of the role. The managerial and professional responsibilities are very different, in my view, to the constitutional and historical responsibilities of a Clerk. I am delighted that we are having a pause, but I would say to the House that we should not simply go back to what we have always known because today the House of Commons is a very different place from in days gone by, and this is a real opportunity to do something that takes the House forward in a very positive way.

Mr Speaker: I thank the right hon. Lady warmly for what she has said and she will know that I concur with those sentiments.

Crispin Blunt: Further to that point of order, Mr Speaker. In the generally successful history of the British Army, some of the most celebrated actions from Corunna to Gallipoli to Dunkirk have involved evacuations from hopeless positions. May I congratulate you on successful disengagement from the opposition forces you have run across? To complete a successful evacuation of your position, I urge you to remember that there are very many of us who do not take the same view as the former Leader of the House, the right hon. Member for Neath (Mr Hain), and that to cover the evacuation it will not be necessary for there to be an unnecessary reorganisation of the affairs of the House. I look forward to your taking views on this matter during the course of the process.

Mr Speaker: I appreciate what the hon. Gentleman has said and the good humour with which it has been said. I first met him, if memory serves me correctly, 25 years and two months ago in Bristol and I have the greatest respect for him. Yes, of course I am aware that there are different views. My responsibility is to hear and seek to heed them. That is what I propose to do.

Debbie Abrahams: On a point of order, Mr Speaker. I seek your guidance, if I may. On the day Parliament rose for the summer, the Government published the Oakley report on the communication and understanding of jobseeker’s allowance sanctions. This is the first opportunity I have had to raise the matter. How can the House scrutinise the Government when they behave in such an undemocratic way? When can we expect a statement from the Government on the inquiry, which is of immense importance to hundreds of thousands of people throughout the country?

Mr Speaker: The short answer is that, at the moment, I do not know. I hope that the hon. Lady will be satisfied—it is perhaps helpful to her cause—that the Leader of the House, who is the ultimate parliamentarian, is in his place. He will have heard what she had to say, and no doubt she will have an opportunity to repeat it at business questions. She will find other occasions on which she can air her concerns.

Nigel Evans: On a point of order, Mr Deputy Speaker—[Laughter.] I meant Mr Speaker. I am looking forward to this response. Mr Speaker—I say that so that it can be cut properly—I am grateful for your statement at 2.30 pm. I understand the personal trauma and uncertainty that Carol Mills must now face. The fact is that she does not know whether she has or does not have a job. Can you assure the House that she will be kept fully informed about what is going on, and that she will know exactly where she stands?

Mr Speaker: The hon. Gentleman served in that capacity as Deputy Speaker and did so with great distinction and loyalty, which is appreciated in all parts of the House and certainly by me. Yes, he has made a very human point, and people will empathise with it. I am in touch with the person to whom he refers, and
	others are. It is important that clarity is established as soon as is compatible with the rights and responsibilities of the House being met and discharged.

Rob Wilson: Further to that point of order, Mr Speaker. Following your statement at 2.30 pm today, it may be helpful if you could confirm to the House the mechanisms by which the House can hold your decisions and your office to account on a regular basis. In the light of the current difficulties that we face over the employment of a senior Clerk, could you also confirm whether any of the participants are taking legal action?

Mr Speaker: I am very grateful to the hon. Gentleman for his point of order. The short answer to him is that I am of course accountable to the House. I chair the House of Commons Commission and hear what it has to say—that is a perfectly proper state of affairs. My understanding is that no legal action has been taken against the House.

Dan Byles: Further to that point of order, Mr Speaker. Having been involved with organising significant organisational change in other organisations—in the military, and in the NHS as a non-executive director of a trust—I know that it is often rife with unintended consequences. The decision to split the Clerk’s role into two is a significant change. Can you assure the House that the decision will not be taken lightly, and that it will be looked at rigorously and robustly, recognising the significant piece of organisational change that it is?

Mr Speaker: Yes, I think I can offer the hon. Gentleman the assurance he seeks. It would be a significant change, and would have to be decided upon by this House. I have sufficient respect for the self-respect and rigorous approach to their duties of colleagues to realise that, of course, they will want to go about their scrutiny seriously before taking any such step.

Julian Lewis: Further to that point of order, Mr Speaker. It is usually unwise for a politician to admit total ignorance, but I have done it before and I intend to do it again. I have to confess that, until this dispute about the Clerk arose, I had not the faintest idea, despite being a Member of this House since 1997, that the Clerk of the House, an expert in procedure, was, by default, also the chief executive of the House. Now that you have sufficiently educated ignorant hon. Members like me about that important distinction, and perhaps about the need to look at the matter rather more rationally than in the past, may I suggest that, as so many other people and bodies are so
	anxious to seize from you the poison chalice of this decision, you should give it to them with maximum rapidity?

Mr Speaker: The hon. Gentleman has been wisely advising me on all sorts of matters since I first came to know him in October 1983. I have very rarely regretted taking his advice, and very much doubt that I would do so on this occasion either.

Christopher Pincher: Further to that point of order, Mr Speaker. I am grateful for your statement earlier in which you made it clear that you believe that the role of the Clerk should be split and the role of the chief executive should be created. Has any estimate been made of the cost of that additional role, and when might that be made clear?

Mr Speaker: I am grateful to the hon. Gentleman. Two points: first, I said what I did not in any mission to browbeat the House, which it is not for the Speaker to do, but simply because I think that there is something to be said for having a view and being prepared, honestly and openly, to express it, and that is what I have done. Secondly, on the subject of costs, there has been to my knowledge no particular assessment of that. There is a consideration of cost; there is also a consideration, resulting from efficient management and strategic direction, of potential savings to the House. If those issues are to be explored, they need, again, to be explored rationally and in the round.
	I am extremely grateful to colleagues for the points of order, for the terms in which they have been expressed, and for the opportunity for this issue to be aired.
	I am very conscious that 35 hon. and right hon. Members seek to contribute to the three debates to take place under the auspices of the Backbench Business Committee, with which, I hope, we can shortly proceed.

bill presented

Freedom of Information (Amendment) Bill

Presentation and First Reading (Standing Order No. 57)
	Grahame M. Morris, supported by Greg Mulholland, John Cryer, Valerie Vaz, Paul Blomfield, Kevin Barron, Ian Mearns, Andrew George, Charlotte Leslie, Caroline Lucas, Rosie Cooper and Ian Lavery, presented a Bill to amend the Freedom of Information Act 2000 to apply its provisions to private healthcare companies and other bodies seeking health service contracts; and for connected purposes.
	Bill read the First time; to be read a Second time on Friday 5 December, and to be printed (Bill 84).

Backbench Business
	 — 
	Hospital Car Parking Charges

Jackie Doyle-Price: I beg to move,
	That this House welcomes the Government’s guidance that hospital car parking charges should be fair and proportionate; notes that some hospitals are still charging patients and their visitors excessive fees of up to £500 per week; further notes that the charity Bliss has said that parents with premature babies are having to pay on average £32 per week; further notes that for many patients it is essential that they travel to hospital by car; believes that such charges affect vulnerable patients at a very difficult time; and urges the Government to consider ways in which hospital car parking fees can be reduced.
	I am extremely pleased to be able to open the debate and I am grateful to the Backbench Business Committee for making time to discuss this important issue, which has been impacting on so many constituents up and down the country. Before I go into my arguments, I must pay tribute to the work of my hon. Friend the Member for Harlow (Robert Halfon), who has done so much to highlight this issue and many others that directly impact on ordinary hard-working people. It is incumbent on all of us in the House, when people’s loved ones are ill or they themselves require hospital treatment, to ensure that the national health service makes the conditions appropriate for them to access the treatment that they need, and car parking charges get very much in the way of that. I reiterate that I thank my hon. Friend for his efforts to push this matter up the political agenda.
	Hospital car parking charges have largely been abolished in Scotland and Wales, but that is not the case in England where 79% of hospitals continue to charge, often at punitive rates. For so many of our constituents driving to hospital is not a choice; it is essential. Many of them are undergoing treatment which means that travel by public transport is simply not an option, particularly when they have to be accompanied by members of their family. Members of their family will also wish to visit them if they have a prolonged stay, and they, too, should not be faced with punitive car parking charges. To put it simply, hospital car parking charges are a tax on NHS treatment.

Jesse Norman: I congratulate my hon. Friend on procuring this debate, and I congratulate my hon. Friend the Member for Harlow (Robert Halfon) on his leadership of the campaign. Does my hon. Friend the Member for Thurrock (Jackie Doyle-Price) agree that at the root of this—I come from Hereford, where hospital parking charges are reportedly some of the highest in the country—is a private finance initiative contract in many cases, which it is often almost impossible for the hospital in question to control? Therefore, there must be wider action to control PFI costs alongside hospitals to support the people whom we are trying to help.

Jackie Doyle-Price: My hon. Friend is quite right. He has done much to highlight some of the PFI contracts, the long-term consequences of which we are now having to deal with, where the contractors may have been rather more savvy in negotiating a deal that suits them
	rather than the patients. We must remember that the NHS should serve the interests of patients, not the providers of any contracts or services within it. I wholeheartedly agree with my hon. Friend and I hope that the Minister will consider what more can be done to challenge some of the contracts.

Geoffrey Robinson: I congratulate the hon. Lady and the hon. Member for Harlow (Robert Halfon) on securing the debate. I think that my hon. Friend the Member for Coventry South (Mr Cunningham) was also involved in that.
	The hon. Member for Hereford and South Herefordshire (Jesse Norman) touched on the heart of the problem. I was an ex-Paymaster General when the Coventry bid was pushed through as a PFI project. We have a magnificent new hospital, but people’s impression of it is not how good the facility is, but how high the car parking charges are, necessitated, unfortunately, by the PFI contract. Does the hon. Lady agree that the key point to put to the Treasury is that these PFI contracts are often too onerous to be sustained by the normal income that the NHS can expect a hospital to generate, and, in particular, the car parking fees built into that are too high?

Dawn Primarolo: Order. I remind Members that about 37 Back Benchers want to speak in three debates that must finish at 10 o’clock, and we must also take the Front-Bench speakers and the proposers. We need interventions to be short, pithy and to the point, and Members must be disciplined if everybody who wishes to speak is to be able to do so. Time is of the essence.

Jackie Doyle-Price: The hon. Gentleman reiterates the point made by my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman). We have all learned a lot of lessons from poorly negotiated PFI contracts. It is worth noting that in Scotland and Wales, the movement to get rid of NHS car parking charges has not been limited by those contracts, and there are ways to see those contracts through.

Bill Wiggin: My friend and neighbour, the hon. Member for Hereford and South Herefordshire (Jesse Norman), has already touched on the shocking situation that we have in Herefordshire, but it is made worse by the county council putting double yellow lines almost everywhere in the city. Ambulances do have to get through, but could not more be done by local authorities to ease the burden on patients?

Jackie Doyle-Price: Absolutely. It is always a good idea for public bodies to be more co-ordinated in how they approach such matters. No hospital acts in isolation, and car parking charges are often a function of how expensive local car parking is.
	I welcome the recent announcement by the Department of Health to strengthen the guidelines given to NHS trusts on the implementation of car parking charges. They include the important provision that relatives of people who are seriously ill or in hospital for a long period should also be entitled to discounted or free parking. The guidelines are clear and welcome, but they do not go far enough. It is important that the House
	sends a clear message to the management of NHS trusts throughout the country that punitive car parking charges are wrong and will not be tolerated.

Jim Cunningham: I congratulate the hon. Member for Harlow (Robert Halfon) on securing the debate; I assisted—if that is the right word—him in that. Does the hon. Lady agree that although car parking charges are far too high for a number of groups of people—my hon. Friend the Member for Coventry North West (Mr Robinson) and I have been campaigning for years in Coventry to get them reduced—it would take the muscle of the Secretary of State to help here, because not all car parking charges are based on PFI. There are hospitals that do not have a PFI, but those charges are built into their budgets.

Jackie Doyle-Price: The hon. Gentleman makes a good point. It is crucial for the Secretary of State to give clear and robust messages about what he expects from NHS trusts. This Secretary of State has probably done more in his period of office to put the patients at the heart of the NHS. We are talking about a rebalancing of the relationship between the patient and the provider. It is simply not appropriate for NHS trusts to decide their car parking charges without considering the impact that those will have on the welfare of patients.

Frank Field: This debate has been part of a campaign initiated by the Opposition on rip-off Britain, and I congratulate the hon. Lady and the hon. Member for Harlow (Robert Halfon) on getting a debate on one aspect of that. I totally welcome the Secretary of State’s guidance on this matter, but we know from our local areas that some hospital trusts will gently put two fingers up to what the Secretary of State says. I very much hope that when the Minister replies he will say what plan B is for those hospitals that continue to charge excessively those who need to continue to visit their relatives in hospital.

Jackie Doyle-Price: I humbly suggest to the right hon. Gentleman, who is not backward in coming forward in expressing his views, that it is up to us in this House to challenge the leadership of our trusts where we think they are being unfair with their car parking charges. Quite frankly, we should be prepared to make lots of noise about that when it occurs.

Several hon. Members: rose—

Jackie Doyle-Price: I would like to make a little more progress.
	The guidance confirms that it is up to local trusts to decide how much and whether they charge for parking but that charges should be proportionate and concessions available. I think we have all seen many examples where charging policy could in no way be described as fair or proportionate. I make particular reference to London hospitals. The Royal Free hospital charges a staggering £72 a day. My constituency is just outside London, but when some of my constituents need to access specialist treatment they are sent to London hospitals. They travel some distance and the fact that they then have to pay punitive charges to access treatment is simply not acceptable.

Lorely Burt: On the ability of trusts to make their own concessions, I want to shed a glimmer of light on an example in my own Heart of England NHS Foundation Trust. It is possible for relatives to buy 20 visit passes for £10, no matter how long they stay. All they need to do is obtain a signature from the ward sister. There are compassionate ways of treating families who need to make regular and sometimes long visits to hospital.

Jackie Doyle-Price: My hon. Friend highlights exactly the kind of initiative that we in this House would expect the local management of trusts to undertake. On having a fair charging policy, we should not have simple flat fees and expect all patients and visitors to pay them. We should be thinking about the best possible opportunities to enable patients to get better when they are being visited by their families and to access treatment without being worried about parking charges.

Karen Lumley: Does my hon. Friend agree that NHS managers could learn from private providers, which in my constituency of Redditch provide two hours’ parking for £1.20, whereas my local hospital trust charges £3?

Jackie Doyle-Price: My hon. Friend has put a very important point on the record. It illustrates again that when management thinks about patients rather than managing the accounts, it can come up with solutions that are good for the patient.
	We have all had many representations from individual patients about the costs they have incurred personally. We have also heard from pressure groups. In particular, Macmillan has highlighted that cancer sufferers have found parking charges to be a very costly element of their treatment, adding significantly to the financial strain for people who are going through prolonged periods of treatment. As I have said, some of them are losing considerable amounts of earnings during that process. We need to be making it easier for them to get better and overcome their debilitating illness.

Guy Opperman: I congratulate my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for Harlow (Robert Halfon) on securing this debate. Of course, it is patients and their families who are the main people affected by this particular issue, but does my hon. Friend the Member for Thurrock agree that surely it is wrong that NHS staff, who do such an amazing job in all our hospitals, are in many cases, particularly in my area, required to pay for the parking in the area where they work, thereby reducing their own salary?

Jackie Doyle-Price: My hon. Friend raises a very important point. One objection to our campaign on parking charges is that somehow the money would be taken away from health care, but I do not believe that is the case at all. He mentions staff. In order to get the best conditions for care, we need to make it easier for people to go out and work, and access to cheap parking is very much a part of that.

Alison Seabeck: rose—

Stephen Lloyd: rose—

Jackie Doyle-Price: I would like to make a little more progress.
	These charges are a tax on the sick. They hit patients and their families when they are at their most vulnerable. It is incumbent on hospital trusts and us in this House to make sure that we create the conditions for patients to have the support to aid their recovery. Simply levying high parking charges will not aid their recovery. We all know that receiving visitors will help. We should be making it easier for them to visit their loved ones.

Alison Seabeck: Will the hon. Lady give way?

Jackie Doyle-Price: I will—persistence pays!

Alison Seabeck: I appreciate the hon. Lady’s giving way in this very interesting and extremely worthwhile debate. Does she share my concern that, in seeking to get profits from car parks, the issue raised by the hon. Member for Hexham (Guy Opperman) about staff being sidelined or being asked to pay more is a problem? We certainly have that problem in Derriford, where staff are now finding it very difficult to park anywhere, if at all.

Jackie Doyle-Price: Absolutely. This comes back to the issue of challenging trusts as to whether the car parking charges are fair. We have had push-back from a number of trust managers who say that it costs money to operate and maintain the car parks, partly because of some of the PFI contracts that have been mentioned. It is simply not good enough, however, for hospital trusts to pass on costs to staff and vulnerable patients when they need to be more challenging about how they manage their finances and not simply take from the patients. Nor is it enough for trusts to argue that charges are reasonable for their area. That is like writing an open cheque and allowing London hospitals to levy extremely high charges. It simply is not good enough. There is, in effect, a parking lottery in the NHS, with some patients able to access health care without any charge for parking their car, while others pay extremely handsomely for the privilege. I find that scenario completely incompatible with an NHS that should be free at the point of use.
	I was shocked to discover that 74% of hospitals make more than £500,000 a year from their car parks, and even more shocked that more than 40% raise more than £1 million. I recognise that there are many reservations about the removal of car parking charges because of the amount of revenue received, but I do not buy it: I think there is lots more that hospital trusts can do to replenish any gaps that might occur in their revenue as a result of removing car parking charges.
	I want to refer to my own local trust of Basildon in that regard. Some will know that Basildon has a very troubled history. It was one of the hospitals that went into special measures following the inquiry into Mid Staffordshire and it has had very high death rates. In the past year, however, since a change of leadership in the hospital trust, it has made massive advances, and it was the first to come out of special measures.
	One of the things that the new chief executive has done is to recruit 200 new nurses, and in doing so she has managed to cut the pay bill because she is no longer relying on agency staff. We can all find other ways of replenishing the money that might be lost as a result
	of reducing car parking charges—not least, I might add, through some patients getting better quicker because they will get more visits from their families. That makes perfect sense to me.

Stephen Lloyd: I thank my hon. Friend for giving way and for facilitating this very important debate. One area she has not yet touched on is the impact on built-up areas such as the one surrounding Eastbourne district general hospital. The car parking charges at the DGH are really quite high, so instead of using the car park people are parking around and about, which is making it very difficult for residents. If it is done badly, it is bad for residents—

Dawn Primarolo: Order. Short means not many words. A large number of Members are waiting to speak. The hon. Member for Thurrock (Jackie Doyle-Price) has now been on her feet for 17 minutes. This is going to be a severely curtailed debate and Members will get only a minute or two unless we can start making some progress. Remember that interventions must be short if there are to be any more. I wonder whether the hon. Lady would consider, in respect to her colleagues who wish to speak, drawing her remarks to a close.

Jackie Doyle-Price: Thank you, Madam Deputy Speaker—I certainly will. My hon. Friend the Member for Eastbourne (Stephen Lloyd) makes a very good point. I would also add that money could still be made by reducing car parking charges but enforcing action against those who should not be using the car park.
	In deference to you, Madam Deputy Speaker, I shall make my comments briefer and move to a close so that other Members can speak, but I just want to reiterate this final point. The NHS is supposed to be free at the point of use, but it is not when patients who have to drive are paying through the nose. Hospital car parking charges are a tax on the sick. We should send a strong message to the managers of all hospitals that we expect them to take steps to reduce this financial penalty on the most vulnerable in our society.

Several hon. Members: rose—

Dawn Primarolo: Order. I will start with a time limit of five minutes. Because we need to get through two other debates, the five-minute limit will apply to all the debates and it may be necessary to reduce it further in fairness to Members who are still waiting to participate in the remaining debates. From now on, you have five minutes maximum on the clock for speeches in this debate.

Yasmin Qureshi: I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on securing this debate. I start with the point on which she finished, which is that the NHS is supposed to be free at the point of use. When we set sometimes exorbitant charges at different hospitals, we are effectively taxing the ill and their families.
	Members have talked about the families of patients in hospital for the long term, with all the costs involved for relatives who visit them. This is honestly not a party
	political point, but in 2009, when my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) was Prime Minister, the Labour party suggested that those who had family members in hospital for a long time should get special permits to enable them to visit without having to pay each time, but that was scrapped in 2010 when the current Government came in. I ask them to reconsider that proposal. One way in which they could act very positively would be to have a similar provision such that the family of those in hospital for the long term can get and use special permits. That would certainly deal with the problem of the long-term ill.
	There is another group of people whom we have not mentioned. We now have an elderly population and most older people have not just one health issue, but several health complications, so they often end up having to go to hospital to see consultants and doctors for six, eight or nine different illnesses or health issues. Each time they go, they or the person accompanying them has to pay hospital parking charges.
	I give the example of my mother, who is 82 years of age. She has several different health issues, and every time I take her to my local hospital—I am her carer—it costs £3, just for five or 10 minutes. I am in the privileged position of being able to afford that, but there are many people in my constituency, who have caring responsibilities for adult and often elderly family members, who may only be on the minimum wage.

Lilian Greenwood: Does my hon. Friend agree that for the many elderly people who do not drive, public transport is a really important issue, just like parking charges? Is she aware that Queen’s medical centre in Nottingham is soon to have the first dedicated hospital tram stop, which will improve access for older and disabled people in particular?

Yasmin Qureshi: I did not know about the Nottingham tram, but I am pleased that people there will have a tram stop to deal with the problem. Something like that would be brilliant in my constituency. There is a bus that goes to my hospital, the Royal Bolton, but because of its location the service is not frequent, so getting there is quite difficult. Such public transport solutions can help people as well. My hon. Friend is absolutely right that many older people cannot drive, so they also have that challenge.
	Perhaps we do not think enough about the number of appointments most older patients have, as do those who are generally ill and have to go in and out of hospital for appointments numerous times. The way forward may be to abolish car park charging full stop, so that a scheme can be applied nationally. The minute we have a discretionary system and leave each hospital trust to decide for itself, some—perhaps because where they are located means they have a large parking space—can charge a small amount, such as 50p, while other hospitals that lack space because of where they are must charge a bit more. Leaving things to discretion means having, as everyone says, a postcode lottery. A better solution might be to make special dispensation, across the whole country, for those going to hospital appointments or those who are in hospital for some days.
	Although I have a legal background, I am not normally an advocate for a lot more law, because it is not always a good idea to have loads of legislation. In this case,
	however, it is worth thinking about having legislation or a directive with the even more novel approach of abolishing such charges altogether. At the end of the day, nobody goes to hospital for pleasure; they go out of necessity and because they are unwell. Therefore, a hospital that raises £500,000 or £1 million, with all the budget it has—

Dawn Primarolo: Order.

Paul Burstow: To pick up the last point made by the hon. Member for Bolton South East (Yasmin Qureshi) about perhaps abolishing such charges outright, later this week the King’s Fund will publish the conclusions of the Barker commission. It is looking at several questions about the future of our health and social care system, and I am sure that it will say things about charging issues and how we pay for parking. It seems to me that such questions must be looked at in the round, and in the context of the overall resources available to the NHS, by asking how to make the best use of those resources to deliver the best possible outcome for patients.
	I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on bringing this matter to the House, as she is absolutely right to do. Hard-working families face difficulties because of the inconsistent way in which different NHS trusts go about applying their policies, and it is right to highlight those that chose to see car parking as another cash cow at the expense of their patients. Hon. Members have spoken about the issue of the PFI and how it further complicates the picture—indeed, it ties the hands of NHS trusts—which is an incredibly important point. The Government need to do more to deal with the mess around PFI so that these things can be sorted out.

Roger Williams: My right hon. Friend will know that hospital parking in Wales is free, but many of my constituents go to Hereford county hospital, which is a PFI hospital. A radiotherapy facility has just been opened there, but that fact is dampened by my constituents having to pay large parking fees.

Paul Burstow: Other Members have already quite rightly intervened to point out how exceptionally high and punitive car parking charges are in that area. If this debate does nothing else, I hope that it make that trust understand that it needs to look to its laurels, review its parking policies and perhaps introduce fairer charging for the future.
	That matter relates to why I wanted to talk about what has been going on in my own patch. Back in 2010, the consumer organisation Which? published a study highlighting my local trust as a particularly bad one, including as one that was quite willing to use clamping regularly as a way to enforce its charging policies. I am pleased to tell the House—this is a model of what others could and should be doing—that the work by Which? spurred my Epsom and St Helier University Hospitals NHS Trust into action: it undertook a review, which involved its patients and carers, and its policy now reflects much of the good practice that we have already heard about in this debate. There is a discounted
	rate of £5 a week for out-patients who visit three or more times a week, those who are going in for dialysis, cancer patients who visit two or more times a week, cardiac rehabilitation patients and immediate family members of patients receiving intensive care or high dependency coronary or neonatal care. In other words, there is an effective policy that makes it affordable for people to visit their loved ones or to get the treatment that they need. More parking for disabled people also came out of the process. There is also a recognition that some people do not want to stay for long, but want to drop someone off or pick someone up. The trust has therefore introduced more short-stay dropping-off places. If the trust delivers an appointment an hour or more late, the parking fee is refunded. Those are the sorts of policies that other trusts could copy.
	It is clear from the work published by Macmillan and others that too many trusts are not even following the guidance, let alone striving to be leaders in the field or to follow best practice. As the Care Quality Commission rolls out and refines its inspection regime for hospitals, it could do more in this area. Perhaps the Minister could ask the chief inspector of hospitals to ensure that car park charging policies are examined. For hospitals that are striving not just to pass muster in inspections, but to be leaders in their field, this is another area in which they could do so.
	Finally, concessions and discounts are only part of the solution. They are only as good as the publicity about them and the public awareness of their existence. It is difficult for people to access something that they do not know exists. It is therefore important to ensure that there is information at the point of use so that people do not wind up paying more than they need to. Will the Minister look at the idea that I and others have put forward recently of a carer’s passport? Some hospital trusts already have it. It is about actively identifying more carers so that they and their families can benefit from concession and discount rates, as well as other facilities to support and ease the burden on family carers.
	The hon. Member for Thurrock and her colleagues who secured this debate are absolutely right that punitive car parking charges and car parking being seen as a cash cow within the NHS cannot be acceptable, as Members on both sides of the House—judging by what has been said so far—are clearly indicating. I hope that in responding to the debate, the Minister will ensure that the NHS gets that message and changes in the ways that hon. Members are suggesting.

Nicholas Dakin: I rise to make a brief contribution to the debate. I congratulate the hon. Members who secured the debate. Already, we can see the value of it, not least from the way in which the last speaker drew attention to the sort of best practice that should be considered by trusts up and down the land.
	In my patch, I have been very concerned about the rise in car park charges at Scunthorpe general hospital. I presented a petition to the House on behalf of local residents and patients in September 2013, which argued that the rises in car parking charges should not go
	ahead. At the time, the Secretary of State advised me that every trust has the autonomy to make decisions locally and that the provision of car parking for patients, visitors and staff should reflect the local situation. I am pleased that he has now gone further in the guidance that he has issued, which I hope will help people such as my constituents, who are taxed for being ill or for visiting the hospital. As the hon. Member for Eastbourne (Stephen Lloyd) pointed out, the impact on parking in the local area is also a problem for local residents. For those two strong reasons, it is important that the movement on this issue is welcomed and that it goes even further.

David Wright: I believe that hospital parking charges should be abolished. The car parks in Telford and Shrewsbury could easily be managed without charges. Some people have expressed the concern that people will overflow- park in hospital parking areas. Tickets could still be issued to ensure that parking spaces are controlled, but it could be made free. The House should push the Government and the Opposition to make a commitment to abolish parking charges at hospitals in the medium to long term.

Nicholas Dakin: I very much agree with my hon. Friend’s point. That has been the thrust of the contributions to the debate. I hope the Minister and the shadow Minister are listening to the voice of the House, which reflects the voice of our constituents as patients and residents who live close to hospitals. Hospital car parking charges should be got rid of in the interests of better, more open and fairer access to health care. The hon. Member for Thurrock (Jackie Doyle-Price) made the point well that increasing the number of visitors increases the speed of recovery. It should therefore be welcomed and facilitated as part of the healing process.

Martin Vickers: As the hon. Gentleman knows, we share the same hospital trust. Patients are prepared to accept that more services are being shared between our two hospitals at Scunthorpe and Grimsby, but does he agree that patients face the double whammy of increased travelling costs and car parking charges at the other end?

Nicholas Dakin: The hon. Gentleman and I work well together on local issues such as health care. He makes the sound point that as we rationalise the way in which hospitals perform to maximise health outcomes, there will be more travelling by patients. Why should there be an added barrier to that travelling and to access? People should not have to focus on things like that, rather than on better health care, when there have to be discussions about where services will be delivered, as there have to be in north Lincolnshire. That is a sound and positive point that supports the point that was made by my hon. Friends the Members for Bolton South East (Yasmin Qureshi) and for Telford (David Wright), which is that the best way forward would be to have free car parking at every hospital as standard.

David Wright: My hon. Friend makes a sound point about rural areas, but it is often difficult for people in urban areas to use public transport as well. Sometimes, people have to change buses several times to get to a hospital. If people in Telford want to go to Shrewsbury, they have to change buses multiple times.

Nicholas Dakin: My hon. Friend makes a sound point. The hon. Member for Cleethorpes (Martin Vickers) and I represent rural areas as well, so the point is well made and well received.

Rosie Cooper: Everybody in the House wants free car parking at hospitals now, but what does my hon. Friend think we can do in the interim to ensure that hospitals stop private car parking companies targeting the disabled and those who arrive in emergency situations? None of that will stop now without proper enforcement.

Nicholas Dakin: I very much agree with my hon. Friend. I am sure that the Minister and the shadow Minister will take that point on board and listen to the other points that have been made in the debate. That will put pressure on hospital trusts to respond positively to the point that she has made.

Robert Halfon: I congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has worked with me from the beginning on this debate on hospital car parking, and the many other Members who have been involved, including Opposition Members.
	We face three problems on hospital car parking. First, it has become a stealth tax on the most vulnerable. It has hit parents who cannot afford to visit their premature baby in hospital. The charity Bliss states that about 30% of parents of premature babies are unable to visit their baby because they cannot afford the hospital car parking charges. Those who can pay an average of £32 a week to visit their sick child. I do not want to live in a country where parents cannot afford to visit their sick children. It was never envisaged that people with cars would subsidise the national health service.
	My hon. Friend the Member for Thurrock set out some hospital car parking charges. The most shocking are those at the Royal Free hospital in London, which I know because, sadly, both my grandparents passed away in that hospital. It costs £500 a week to park a car at that hospital. If there was ever an example of how hospital bosses have used car parking charges as a stealth tax, the Royal Free hospital provides it.
	People say that we have to have these charges, but why is there such a wide range of charges across the country? Why do 25% of hospitals not charge at all? I am ashamed to say that my own county of Essex is one of the most expensive areas outside London for hospital parking charges. Why do so many hospitals in the north of England not charge at all?

Tim Loughton: My hon. Friend has done a fantastic job of leading this campaign. On the subject of neonatal intensive care, there is an added problem. Because of the shortage of facilities, parents often have to travel long distances and pay for accommodation in order to stay near their children overnight. It adds insult to injury that they have to pay hospital parking charges as well. This is a treble whammy, and the charges are particularly unjustified in such cases.

Robert Halfon: My hon. Friend highlights the problem exactly. It applies not only to the parents of premature babies but to people with cancer. Indeed, 10% of hospitals do not give people with cancer any kind of concession at all.
	There is also a problem of transparency. No one knows why such huge increases in charges are taking place, and no one knows exactly what the money is being spent on. Southend hospital, in Essex, charges £2.50 for the first hour’s parking. It was highlighted on BBC Essex recently that the hospital had spent more than £7 million on a new multi-storey car park. Even Harrods and Selfridges would not spend £7 million on a car park. The hospital increased its charges in 2011 and raked in nearly £1.4 million in parking fees alone. It was never envisaged that hospital parking should become a cash cow or a tax on the vulnerable and the sick.
	We should also remember that it is not only the patients, the vulnerable and those who are visiting them in hospital who face this stealth tax. It is also a tax on nurses, who are paying an average of £200 a month just to park their cars so that they can do their job. If we had to pay that amount to park our cars here at the House of Commons, I am sure that the practice would be stopped immediately. I also want to mention the concessions for people with disabilities. We often need a PhD to understand all the different rules and regulations involved. We need clear guidelines, and I welcome what the Government have said about this over the past week.

Steven Baker: I want to set in context what my hon. Friend has just said about the scale of these charges. I have just checked the cost of parking at Chiltern Railways’ new multi-storey car park in Wycombe, and it is only £7.50 a day. I say “only” because that seems quite good value given that some people are paying £500 a week for hospital parking. Does he share my amazement that hospitals manage to provide so little parking for so much expense?

Robert Halfon: My hon. Friend hits the nail on the head. As I have said, this has become an easy way for hospital bosses to raise money, and there has been no dialogue with the public about it.
	People say that the money could be spent elsewhere, but I believe that hospital parking is as much a front-line service as anything else. It is as important as how many nurses and doctors there are. I am glad that the Government have spent an extra £12.5 billion and that there are 3,000 extra nurses since the coalition came to power, but hospital parking is as much a front-line issue as those things and it should be put into the general pot of NHS spending. It should be taken into account in the same way as spending on nurses and doctors and on machinery. That is often forgotten.
	The hon. Member for Bolton South East (Yasmin Qureshi) said that no one goes to hospital out of choice; people go because they have to, or because they have to visit relatives or friends. They should not suffer in the way that they do. They should not have to face the stress involved. Many of my constituents have contacted me to tell me of the stress they face when, having paid at the car park machine, they have to wait for a doctor’s appointment that should have been at, say, 11 but does not take place until 1 o’clock. Through no fault of their
	own, they have to pay extra car parking charges as a result. How can that be right? Again, I welcome what the Government have said about that.
	We need to look at this as part of the front-line spending on the NHS. Estimates suggest that it would cost between £200 million and £250 million to scrap hospital parking charges. I believe that the Government should set up a special fund, possibly paid for by using more generic drugs, and I urge the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) to look at that proposal. I welcome the fact that he has listened, and that the Government have published some really tough guidelines for hospitals. I recognise that they are not the ten commandments; they are not written down on tablets of stone, and we cannot force hospitals to comply with them. They are the next best thing, however.
	I put it to my hon. Friend the Minister that if hospitals do not comply with the guidelines, and that if they continue to fail to offer proper concessions to people with disabilities, to use hospital parking as a stealth tax on the vulnerable, to charge their staff for parking and to perpetuate the lack of transparency which means that no one can understand what the revenue is being spent on, we should scrap hospital parking charges completely, as Opposition Members have suggested. I hope that we are already moving in that direction.

Bob Blackman: It is an honour to follow my hon. Friend the Member for Harlow (Robert Halfon), who has been at the forefront of this campaign. I trust that, now that he has the ear of the Chancellor, he will use that power to persuade our right hon. Friend of what needs to be done. Earlier this year, I went to see the Chancellor with a delegation led by my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), and we put it to him that hospital parking charges should be scrapped altogether. I note that it is now estimated that the cost of doing so would be £200 million. At the time, it was £90 million.
	We should look at this matter strategically and say that anyone who is going to hospital for treatment or to visit people who are suffering in hospital and who need to be there for an extended period of time should be exempt from all charges. It is difficult to introduce such a policy across the country for the simple reason that hospitals are in different locations. Some are co-located with stations, for example, and have decent public transport links. Others do not, however. We need a policy whose presumption is that anyone using the hospital car park because they are using the hospital services as I have described should be able to do so free of charge.
	Such a policy could be implemented by requiring people to pay on exit. They could obtain a ticket on entry and have it stamped by a ward sister or a similarly appropriate medical person in order to exempt them from paying the charge. That would prevent commuters and others from abusing free hospital parking places.
	I trust that we can look at this matter as a sensible investment. We clearly cannot expect the Department of Health to find the money itself. We expect it to provide the funding for treating people who are sick.
	We should look to the Treasury to provide the health service with the necessary funds to enable this initiative to take place.

Marcus Jones: I completely agree with my hon. Friend that hospital parking charges should be scrapped. In the meantime, however, does he agree that when a hospital is at fault for delaying or cancelling an appointment, the patient should not have to pay more for their parking as a result?

Bob Blackman: I thank my hon. Friend for that intervention.
	I was just coming on to the specifics of my area. My constituency and others now have centres of medical excellence, which means that people have to travel long distances for the treatment that they need. Many of them have to use their cars, because public transport is not an option. Over the past 18 months, I have witnessed people suffering when their appointment was delayed and they had to rush out to the car park to pay more at the pay and display machine. Such an encumbrance is unfair on people who need to receive important medical treatment, and it should without doubt be scrapped.
	The guidelines should also stress strict adherence to a policy of paying on exit for the appropriate length of time spent in the car park, as opposed to using pay and display arrangements that involve people guessing how long they are going to spend in the hospital. I have witnessed at first hand people having to guess in that way and then finding that they do not need all the time they have paid for.
	In my own area there is Northwick Park hospital, which is the centre at which many people from north-west London are treated, and Central Middlesex hospital, which is in the middle of an industrial estate and almost inaccessible by public transport, so anyone going there has to drive. There is no pay-on-exit facility available. In fact, the trust took away that facility and insisted that the parking area that was built for it be replaced with pay-and-display parking. It was a nonsensical decision, and I trust that the trust will review it and revise it accordingly. We also have Ealing hospital, which has a similar problem of not being anywhere near any public transport facilities. The tube lines run into the centre of London rather than radiating around the outside, so people travelling locally have to drive and use the car parking facilities.
	I wish to touch on a specific case that I came across recently, that of Mr Francis Bacon, a registered disabled driver who suffered a serious puncture while driving to a hospital appointment. He was unable to move his car, which some good samaritans pushed on to the pavement while he went to get help to change his tyre. He got his tyre changed by some good people who came and helped him and put him on his way. Sadly, a parking operative from Ealing council had come along and put a penalty notice sticker on the car, because Mr Bacon had had the temerity to park on the pavement. He could not move his car—his car was disabled, and he was disabled—yet he still got a parking ticket. Despite protestations from everyone concerned, Ealing council refused to cancel the ticket, which is typical of the wrong attitude of both local government and hospital trusts themselves. We need them to work in harmony to promote parking arrangements that suit and protect
	everyone. I trust that we can use this opportunity to encourage the Chancellor to provide extra funds so that we can do away with car parking charges once and for all.

Stewart Jackson: I join in the congratulations to my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for Harlow (Robert Halfon). This is precisely the type of issue for which the Backbench Business Committee was established, so that we can try to alleviate the problems of people who feel their voice is rarely heard when set against a big bureaucracy.
	Parking charges are an important issue because there are both philosophical and practical problems with them. Philosophically, it was never the intention that patients should be forced into a back-door stealth tax by virtue of the fact that they drive a car and need to park at a hospital. Health care has always been funded through general taxation, not patient charges, and that principle has been established by all parties. Also, surplus income has been ring-fenced for NHS activities. We run the risk of undermining the philosophical underpinning of the NHS. I accept that this is a cross-party matter, because Labour also sought to deal with it when it was in government.
	In practical terms, parking charges cause real hardship for the simple reason that they are a regressive type of taxation that hits the elderly, the poorest and the sickest at the most vulnerable times in their lives. We have heard about various cases today. There are bigger issues involved in the debate, too, including our friends the West Lothian question and the Barnett formula. There is a question of fairness and equity, because people in Wales and Scotland do not suffer a similar encumbrance. Effectively, my constituents in England make a capital payment for free parking at health care facilities in Wales and Scotland, which cannot be right.
	As my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) said, there is a bigger strategic financial issue to consider—the impact of the private finance initiative, particularly schemes such as that in my local trust, the Peterborough and Stamford Hospitals NHS Foundation Trust, which incidentally has a structural annual deficit of £40 million and so finds it difficult to deal with such matters. Both the Treasury and the Department of Health should consider the irreducibility and intractability of the debt encumbrance on such trusts, which forces them to seek finance in that way. I hope that Ministers will think in such wider strategic terms.

David Wright: I agree with pretty much everything that the hon. Gentleman has said. One big problem is that many hospital trusts have gone into fairly long-term contractual arrangements with private sector car parking providers. Alongside the broader points that he makes about hospital funding and PFI, the Government should examine the structure of the parking contracts that hospital trusts have put in place. One of the few ways in which they can help in that regard is through national guidance. The Government should take a lead and say to hospital trusts, “You must review this.”

Stewart Jackson: The hon. Gentleman is absolutely right, and he touches obliquely on another issue—that of transparency, which some of my hon. Friends have
	mentioned. It should not just be through freedom of information requests by my hon. Friend the Member for Harlow that we get the relevant data before us. Incidentally, my local trust substantially increased its parking revenue from £1.56 million to £1.71 million in one fiscal year. Transparency throws up some perverse practices, such as the fact that at Stamford hospital, in the constituency of my hon. Friend the Member for Grantham and Stamford (Nick Boles), a small community hospital, there is no requirement to pay for parking, but people have to pay at Peterborough hospital, which serves virtually all my constituents. I do not think that is right.
	I believe that there is a direct correlation between a wider lack of NHS transparency and high car parking charges. I cannot prove that, but it is my instinct. I say that having found out only a few weeks ago that the interim chief executive of the Peterborough trust was paid more than £400,000 a year for a four-day week. He did a good job, but at some cost to the taxpayer. Parking charges fall within that narrative, because patients should be allowed to know the costs of parking and the income received from it. As my hon. Friends have said, people parking at hospitals are vulnerable, stressed and upset, and things outside their control—bureaucracy, delay, getting the wrong treatment or whatever—can mean that they have to stay at a health care facility, such as a big acute district hospital, for longer than they would otherwise have to.
	My hon. Friend the Member for Harrow East (Bob Blackman) made a good point about centres of excellence. In my area, the eastern region, people have to travel 30 or 40 miles. Someone with a child who has a poorly heart might have to travel from south Lincolnshire to Addenbrooke’s hospital or other places, which is difficult.
	It would be churlish not to mention the Government’s guidelines. I welcome them, but we need to be tougher and we need a fiscal incentive for trusts to do the right thing—hopefully, abolishing parking charges. We need to punish trusts if they arbitrarily disregard the Government’s guidelines. Hopefully my hon. Friend the Member for Harlow, with his legendary powers of persuasion that we have seen in the past four years, will ask the Chancellor to take the appropriate action. Ultimately, we should work to abolish parking charges completely, because they are an insidious, pernicious tax on the most vulnerable people in our society.

Heather Wheeler: Some of my colleagues have talked about parking arrangements needing to change so that instead of getting a ticket at the beginning of their stay, people pay at the end. South Derbyshire has free car parking for everything, but it does not have a hospital, so my constituents have to travel to Burton, to Glenfield in Leicester or to the Queen’s medical centre in Nottingham, and they have to pay. Burton hospital has changed its arrangements, along with a company called ParkingEye, and there has been a huge outcry. Part of the arrangement is that people have to remember when they came in, and when they go out they pay according to when they came in. They do not get a card that tells them when they came in. They might be rushing to take a child into A and E, or they might be a bit elderly and have eyesight that is not so good—I am coming and going with my glasses
	these days, so I feel their pain. A number of constituents have come to me in absolute outrage, because when they get it wrong they get a £70 fine. I am delighted that on every occasion I have been able to appeal to the chief executive and get that fine removed, but what an incredible waste of her time and mine, let alone the angst and anger of constituents.
	We love our local hospitals. Burton hospital has been going through tough times, but it is our hospital. This system has been imposed on my constituents, and I am not happy about it. Fortunately, I have a good working relationship with Helen Ashley, the chief executive, and she is trying her best for our local hospital. She has reviewed the arrangements for ParkingEye and got it to make the press button keyboards and wording on the signs bigger, and to put more signs all the way round, but still the principle applies—what a daft system! I cannot believe the hospital has ended up going down that route and think that national guidelines would be excellent. Like everybody else, I congratulate my hon. Friends on securing this debate and the Minister on setting out guidelines over the past few days. That is a major step forward, but I implore hospitals, who are there to serve the public—just as we are in this Chamber—for goodness’ sake to put the patient first.

Robin Walker: I congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on introducing the debate, and my hon. Friend the Member for Harlow (Robert Halfon) on his excellent speech and championing of this cause.
	This is a huge issue in Worcester and has been for the eight years I have been banging on doors in the area. It came up regularly over the summer recess, so I apologise to the House if I am a little parochial in my arguments. As my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) pointed out, the private finance initiative is a big part of this. In Worcester it is a big part of the problem with capacity rather than just cost, and a lot of the land that was originally intended for parking was sold off because of the appallingly bad negotiations over PFI by the previous Labour Government.
	Parking is not just a problem for patients, as the motion states, but for family visiting and—as my hon. Friend the Member for Hexham (Guy Opperman) pointed out—for staff. On top of that, it is a massive problem for people who live in the local area around the hospital when staff are effectively encouraged to park for free in residential streets. I have had complaints over the years from residents of Leopard rise, Aconbury close, Darwin avenue and Linksview crescent, which are all close to Worcestershire Royal hospital, about people not being able to park outside their homes.
	Charges at Worcestershire Royal hospital are not quite as high as those mentioned in the motion, but as my hon. Friend the Member for Redditch (Karen Lumley) pointed out, they still start at £3 for two hours, which is more than people are charged for parking in Worcester city centre. For many people, costs can swiftly mount up. Someone visiting for one hour each day for a week could end up paying at least £21, and information about concessions, which is badly needed, does not always reach those who need it most. The hospital trust currently
	makes more than £400,000 profit on its parking overall, and by contrast with the new guidelines there is no difference in charges for the disabled and other users of parking spaces. There are some reserved bays, but 52 bays out of 1,543 does not seem enough to me or most of my constituents.
	As I said, parking capacity is a massive problem for staff, and it is about to become much worse because the park and ride used by many staff was, until recently, subsidised by the county council. It has had to reduce that subsidy, and the hospital trust has agreed to take it over, but only temporarily. This is an urgent time for the Worcestershire Acute Hospitals NHS Trust to review its approach to charging staff and the public.

Fiona Mactaggart: May I reinforce the hon. Gentleman’s point about staff? Enabling nurses in particular to park near where they work means that hospitals can recruit nurses. In my constituency, if nurses live within five miles of the hospital, they are not able to get a parking space and have to pay high charges. In practice, most of them get on the train to St Mary’s in Paddington and work there rather than in Slough. That means that my constituents get a less good quality of care.

Robin Walker: The hon. Lady makes an excellent point, and I welcome the fact that the Government’s new guidelines suggest a concession for staff who may not be able to get to work by public transport. That is important, but it would be so much better if the charges were not there in the first place.
	Concessions for patients at Worcestershire Acute Hospitals NHS Trust are largely good. There are £1 tickets for a day, including for terminally ill patients, people undergoing coronary care and those in an intensive therapy unit or in oncology and paediatrics, but not for those who may have suffered a premature birth, for example, or have complexities during maternity leave—my hon. Friend the Member for Harlow was right to raise those issues. The concessions are also for relatives attending the bereavement office but not for other relatives. An £8 weekly ticket is available for next of kin, which most people do not know about, and there are £1 weekly tickets for renal patients and people undergoing radiotherapy, but they still have to be applied for on the wards, and only after people have paid £3 for parking in the hospital in the first place. That is one of the absurdities of the current system of charging on entry, rather than on exit as the Government suggest.
	I would like much better advertising of concessions, and I think a simpler system would be good as it would be easier for people to understand. As many colleagues have said, getting rid of parking charges altogether would put us in a better place. My only worry about that would be if it disincentivised hospitals from investing in capacity, because in hospitals like mine there is a clear need for new capacity. Lack of parking capacity at Worcester has been made worse by temporary disruption from the construction of a new radiotherapy unit—something I strongly support. Other hospitals, however, such as that in the constituency of my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones), have delivered multi-storey car parks in time for such upgrades to their hospital, and I wish that Worcestershire Royal hospital had been able to do that.
	I welcome the fact that the planned breast unit at the hospital will come with its own parking, which I hope will contribute to addressing overall demand. I have raised the concerns of my constituents about hospital parking time and again, but it is right to show leadership in the House and for the Government to address the matter properly.
	My final point is about accessibility and ease of payment. Asking people to pay in cash up front is unacceptable in this day and age. Worcester city centre has schemes where people can pay for parking by card or with their phone. People use those schemes; they are popular, and I urge Worcestershire Acute Hospitals NHS Trust to consider how it can implement such a scheme to make it easier for people who do not have ready cash to hand. If I take one thing from this debate it is that I hope my trust acts like that of the right hon. Member for Sutton and Cheam (Paul Burstow), and reviews its policies on these issues immediately, taking a lead from the guidance the Government have set and the arguments made in the House.

Guy Opperman: Like my hon. Friend the Member for Worcester (Mr Walker), I would like my trust to review its approach to parking charges at Hexham hospital and in the region.
	I will start my short speech by pointing out that I have probably spent more time in hospitals as an acute patient than virtually any other Member of the House, and I have certainly had my life saved on two separate occasions. More particularly, I have seen on the many occasions that I was visited by family and friends the degree of worry in the wards that I was in, whether with a brain tumour or as an injured jockey. The last thing people need at such times is to worry about parking and similar matters. That is not the right approach, and it is wonderful that the House is debating the issue today—as always, full praise is due to my hon. Friends the Members for Harlow (Robert Halfon) and for Thurrock (Jackie Doyle-Price).
	The direction of travel is clearly good, with the Secretary of State’s announcements over the summer, today’s discussion, and the sharing of innovative ideas. The hon. Member for Solihull (Lorely Burt) made a fair point about the alternative ways that such issues can be approached, and we all agree that at times our trusts seem not to talk to each other to develop an alternative way forward.
	Northumbria NHS Trust is an outstanding trust with exemplary staff and quality service, and Hexham hospital charges are well below those of many trusts. There is free disabled parking and concessions for some patients and visitors. It has got rid of the dreaded ParkingEye that so many people complained about, but problems still remain and there are complaints not only from individual constituents but from the staff who are effectively required to use the hospital car park if they wish to get to their job. That cannot be right. I endorse all the comments about how we need to review that and change the system.
	In Northumberland, we have managed to remove local authority parking charges, so a visitor to Hexham is entitled to free parking. As a consequence, the one argument the town centre hospital had for charging has disappeared. We therefore have the bizarre situation
	where it is free to park in the town, but expensive to park at the hospital. The Network Rail station, Marks & Spencer and the hospital are the only three organisations charging for parking in the local area, whereas in the town it is now free.
	Sadly, the trust is not prepared to reduce or cancel the parking charges. We can all understand why parking charges should be imposed where a hospital is in a town centre and where, sadly, members of the public would use free parking to avoid a Northumberland county council car park or alternative private cark park—there is ample evidence for that—but we need to balance the two arguments to ensure a flexible approach. Then we can have an individual policy for the town.
	In rural Northumberland, well over 90% of journeys to the hospital are made by car. Mr Deputy Speaker, you have kindly granted me a debate on rural transport in Northumberland, so you know that I shall be raising the absence of bus, train and alternative provision to Northumberland town centres this Wednesday evening at 7.15 pm. Currently, however, the harsh fact is that those journeys have to be made by car. As I have indicated, we have received many complaints from members of staff and constituents, and I endorse the favourable comments about the Macmillan report on the treatment of cancer patients and the findings of the charity Bliss which my hon. Friend the Member for Harlow outlined so eloquently.
	There is a cost to this process, but if we all stopped using hospital car parks, hospitals would not benefit from the charges, so, bizarrely, unless the trusts act, all of us will attempt to boycott them and use alternative means, in which case they will be the ones facing the costs. Trusts need to review this policy in the light of their individual circumstances—town centre parking and other parking facilities in their areas—and ultimately change it, because this policy is wrong.

Andrew Gwynne: It is a pleasure to follow the hon. Member for Hexham (Guy Opperman). I also thank the hon. Member for Thurrock (Jackie Doyle-Price) for opening the debate in a very thorough and meaningful way. There has been a large degree of consensus across the Chamber on this important issue.
	The Opposition welcome any move that could help to ease the financial burden on those suffering from illness. As said, when people go to hospital, the last thing they want to worry about is keeping the car parking ticket up to date. For some patients and their families, the costs can really rack up, and we have seen big increases in charges in recent years, adding to the cost of living crisis facing people up and down the country. In the past four years, more than a quarter of hospital trusts have increased their charges, some of them substantially, as we have heard today, and it cannot be right either if some people do not get visitors because they cannot afford the parking fees. We know that having friends and families around helps patients to get better quicker, which can save the public purse—the NHS—money down the line, as several hon. Members have pointed out.
	As we have also heard, the problem extends to staff, too. In my role as a shadow Minister, I get to visit hospitals around the country. A nurse working in Liverpool told me fairly recently how unfair it was that she had to
	pay for parking, even when her shift ended past 10 pm. She said she often felt vulnerable when using public transport at night, yet she had to pay extra for the privilege of using her own method of transport. Even when public transport is still running, it is not unreasonable to expect better treatment when working late hours.
	It is right that we debate this issue today, and I pay tribute to the Members who secured this debate and to the Backbench Business Committee for finding the time to have it in the main Chamber. I also pay tribute to Members on both sides of the House, particularly the hon. Member for Harlow (Robert Halfon), who has pushed this subject on to the Minister’s desk. Despite the consensual nature of Backbench Business Committee debates, it would be wrong of me not to point out that this issue was on Ministers’ desks back in May 2010, when the previous Labour Government left fully costed plans to phase out charges for in-patients—to be fair, the hon. Member for Peterborough (Mr Jackson) mentioned that. Our plans would have seen patients given a permit to cover the length of their stay that visitors could also use to park for free.
	The hon. Gentleman also touched on the important issue of information. I do not wish to enter into a game of hospital top trumps with the hon. Member for Hexham, but in 2010 I also spent an awful lot of time in my local hospital through illness. Three weeks into an eight-week stay—my first of two long stays in hospital—my wife was told that she could apply for a parking permit. It was not advertised; somebody mentioned it in passing when she was visiting me in the high-dependency unit. Frankly, that is not on. If there are permit schemes, it should be advertised to all patients and their visitors.
	We were also consulting on extending free parking to out-patients, and I want briefly to pay tribute to Macmillan Cancer Support for its campaign on this, but for whatever reasons, Health Ministers shelved our plans soon after the election. At the time, they said there were better uses of public money. I am pleased that there has been an apparent change of heart. Members can imagine my delight in the summer recess when, reading the news, I learned that Ministers had changed their minds. “Victory over parking cowboys” and “End of the hospital parking rip off”, the headlines read. I think we know it is probably not quite as simple as that. Perhaps the Minister will admit that, despite their good intentions, the Government have no power to force hospitals to follow these laudable principles and that trusts are under no such obligation. Is it not the case that all the Secretary of State has done is effectively to amend existing guidelines to suggest that some people should not have to pay to park?
	One of the few changes to the guidelines is the addition of pay-on-exit schemes, which is something that we have discussed tonight and which I fully support. As we have heard, appointments often take longer than planned. However, these schemes come with their own additional costs, which was why I was interested in the suggestion from the hon. Member for Harlow of a special fund. Is the Department of Health considering that and will it be contributing towards the purchase and installation of the new equipment and software, not to mention the lost revenue from people paying less across the board?
	More broadly, will the Minister confirm that there is no new money attached to the implementation of any of these guidelines? When money is tight, is there not a huge danger that some trusts will be left with the choice of either implementing the principles, which we all support, or threatening to cut back on services? That point started to come out in the arguments put by Members. Indeed, that is exactly what one hospital has already warned about. A governor at Dorset county hospital said:
	“When the government makes announcements like this, it has an effect right the way along the line. The money has to come from somewhere.”
	That was why I was interested in the special fund idea suggested by the hon. Member for Harlow. It needs proper consideration by the Treasury and the Government.
	Is there anything to prevent trusts from no longer offering parking as part of their hospital provision and selling off any car parks they might have developed—particularly multi-storey car parks—with capital costs to a private operator? If we are not careful, that could be one of these unforeseen consequences. Forgive my scepticism, Mr Deputy Speaker, but the problem is that the Government are trying to use the carrot-and-stick approach without either a carrot or a stick. It reminds me of when a public health Minister told a crowd that the Health and Social Care Act 2012 had pretty much given away the Government’s control of the NHS. That is the real reason why I fear those headlines possibly will not match the reality, because the Government have given away so much day-to-day control that I fear they are powerless to do anything about ever-increasing car parking charges, particularly if no funding follows that. The former Health Secretary would be more than entitled to ask the current Health Secretary, “Whatever happened to operational independence?” The guidelines are not mandatory on hospitals, so what confidence can we have that trusts will pay even a blind bit of notice to the new regulations?
	Members are right to raise this issue and to push the Government further on it. The aims are laudable, and anything that helps people with the squeeze on living standards, especially at a time of need, when somebody is in hospital, has to be welcome. The challenge for the Government now is actually making it happen.

Daniel Poulter: I would like to begin by congratulating my hon. Friend the Member for Harlow (Robert Halfon) on securing this debate and my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on her opening speech, which outlined a number of the key issues, about which we are all concerned and to which a number of Members have referred. I understand and have listened to the concerns expressed, both in this House and by the public more generally, about car parking in our NHS, especially where the cost is high and can be considered a rip-off for patients, their families and, sometimes, NHS staff. That is why we published the new NHS patient, visitor and staff car parking principles last month, which will lead to new guidelines at the beginning of next year.
	Before I address those principles and respond in more detail to some of the points raised, it is important to pick up on the key issue that has been outlined—my
	hon. Friend the Member for Thurrock raised it in her opening remarks—which is that, for a patient, driving to hospital is not a choice; it is essential in order to receive important and, often, life-saving treatment. It is also important for relatives and those wishing to support and look after friends and others who may be admitted to hospital through no fault of their own. It is right to say, as my hon. Friend did, that Basildon was a challenged trust, but addressing the challenges of that trust, both financial and in terms of patient care, should not come at the expense of short-changing patients. There are many other measures that trusts need to look to—such as improving their procurement practices, better managing the NHS estate and, in the long term, lowering costs by reducing their dependence on temporary staffing—to balance their books and ensure that as much money as possible is directed to front-line patient care.
	My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) made a number of important points, including the key one that car parking should not be a cash cow and needs to be seen in the context of the wider sustainability challenge of the NHS, and that many trusts are still paying the price for poor PFI deals that they signed up to under the previous Government. He also asked what role the CQC could play in addressing the issue if parking charges were prohibitive. Of course there is a role for the CQC. If concerns were raised about patients being prevented from accessing the NHS care they needed as a result of prohibitive car parking charges, the CQC could of course make recommendations and raise that with the trust as part of its inspection regime. The power for the CQC to do that exists at the moment, and I am sure the chief inspector of hospitals will be mindful of that as part of the inspection regime.
	We had many other good and important contributions, including from my hon. Friends the Members for Harrow East (Bob Blackman) and for Harlow, who spoke very eloquently and outlined clearly the reasons for calling this debate. We also heard from my hon. Friends the Members for Peterborough (Mr Jackson), for South Derbyshire (Heather Wheeler), for Worcester (Mr Walker) and for Hexham (Guy Opperman), all of whom spoke eloquently. In the time available to me, I will do my best to pick up on some of their points in my broader remarks.
	We talk about the fact that there are many examples of unacceptable practice in hospital car parking, but it is important to highlight the fact that 40% of hospitals that provide car parking do not charge and of those that do, 88% provide concessions to patients. However, I am aware that there are 40 hospital sites—which is 3.6% of hospitals in acute and mental health trusts—that have charges and do not allow concessions to patients who need to access services. As a Government, we want to see greater clarity and consistency for patients and their friends and relatives about which groups of patients and members of staff should receive concessions and get a fairer deal when it comes to car parking. It is exactly for those reasons that we published the principles that will underpin the guidance that will be published in February or March next year about how we deliver fairer car parking charges, of which all trusts will be expected to be mindful.
	I want briefly to outline some of the key points in that guidance. We want to see concessions, including free or reduced charges or caps for the following groups:
	disabled people, frequent out-patient attenders, visitors with relatives who are gravely ill, visitors to relatives who have an extended stay in hospital, and staff working shifts that mean that public transport cannot be used. Other concessions—for example, for volunteers or staff who car share—should be considered locally. The list I have given is not exhaustive—we will return to it as part of the guidance we produce early next year—but it is important that we have much greater consistency and clarity from all hospitals about which groups should receive parking concessions and free parking when that is appropriate.

Frank Field: It is quite clear that the Government have a model in mind of the minimum standards that hospitals should subscribe to, which is welcome. Will the next round of consultations that the Government undertake with hospital trusts outline what will happen to those that pay scant regard to what the Government are suggesting?

Daniel Poulter: It is exactly because a small minority of hospital sites have no concessions at the moment, which is unacceptable and not fair to patients—I outlined 40 such sites that I am aware of in acute and mental health trusts—that we brought forward the principles and are refreshing the guidance. We need to see hospitals respond to that guidance. Powers are already available to the CQC and the chief inspector of hospitals for the CQC to take action, if appropriate, if there is behaviour in a hospital that makes it prohibitive for patients to receive treatment. However, we also need to look at what other measures we can introduce against trusts that still show disregard for the guidelines, to make it clear that doing so is no longer acceptable. For example, mechanisms are available to us when we give finance to trusts to ensure greater conditionality on that finance in future.
	That is something we would certainly look at seriously as a mechanism for enforcing better behaviour, but I am hopeful, thanks to the fact that we will have refreshed guidance and that many patient groups are championing this issue at the local level. My right hon. Friend the Member for Sutton and Cheam made the point articulately that patient action locally meant that St Helier hospital, which was one of the worst offenders for car parking charges and disregarding the rights of patients and staff, has reformed its ways. Patient action has led to improvements. A number of mechanisms are already in place and, with the guidelines, I am sure we will get to a much better place across all trusts. However, if necessary, we have other measures, when we are giving finance to trusts, to put levers in place.

Frank Field: Does the inspector have powers to instruct the groups that will probably pay scant attention to the guidelines to make the changes that the whole House wants?

Daniel Poulter: If concerns are raised as part of a care quality inspection that patients are receiving sub-standard care or not receiving the quality of care that they should be as a result of being unable to access services, there would of course be a role for the chief inspector of hospitals and the CQC to raise that as part of their inspection report. I am sure that is something the chief inspector will bear in mind for the 40 hospital sites that
	at the moment do not have concessions for those who are very unwell or who are disabled. I am that those trusts, which will be listening keenly to this debate, will bear that in mind and will want to take action, hopefully before the refreshed guidance is produced.
	I know that time is pressing and I do not wish to detain the House much further, but I want quickly to outline a few of the other measures that are in place as part of the principles that will underpin the guidance, which hopefully will reassure right hon. and hon. Members that the Government have taken appropriate steps to address these issues.
	Staff parking is an important issue. I probably speak as the only Member—currently, at least—who, as a practising hospital doctor, has genuine, first-hand experience of this issue. It is important to look after our front-line staff. Car parking in hospitals should not be allocated according to staff seniority or because someone happens to be a senior manager; it should be allocated according to the needs of staff and the type of care and shift patterns they provide. That is made very clear in the principles underpinning the guidance to be published.
	On payments for hospital parking, our principles say that trusts should consider pay-on-exit or similar schemes, whereby drivers pay only for the time they have used, and fines should be imposed only where they are reasonable and should be waived when overstaying is beyond the driver’s control. Details of charges, concessions and penalties should be well publicised, including at car park entrances, wherever payment is made, including inside the hospital. The issue has been raised of the sharp practice sometimes carried out by the management of car parks in hospitals, and we have made it clear in the principles underpinning the guidance that those practices are unacceptable.
	Finally, on contracted-out car parking—another issue raised in the debate—NHS organisations remain responsible for the actions of private contractors who run car parks on their behalf. NHS organisations are expected to act against rogue contractors in line with the relevant codes
	of practice, where applicable. Contracts should not be let out on any basis that incentivises fines—for example, income from penalties only. This Government expect hospitals to take action against contractors who behave irresponsibly, short-change people and behave badly towards patients, their relatives and staff.
	I hope that I have reassured the House, particularly those who brought this debate before us today, that this Government take the issue very seriously and believe that unacceptable behaviour by hospitals and unacceptable hospital car parking charges will become things of the past.

Jackie Doyle-Price: I thank all Members who have participated in this debate, which, in displaying zero tolerance for punitive car parking charges, has been a rare show of unanimity. When the House reaches a consensus on such issues, it is all the more powerful.
	I would like the Minister to take away the message that some examples of very bad practice have been highlighted, as well as some examples of good practice. That must be disseminated, to show exactly what we will not tolerate. Perhaps we should look more at naming and shaming trusts that are not stepping up to the plate and not doing the best for their patients. At its heart, this issue is about the relationship between patients and providers, and whether the latter are doing everything they can to put the interests of patients first. We must continue to apply pressure to ensure that they do exactly that.
	Question put and agreed to.
	Resolved,
	That this House welcomes the Government’s guidance that hospital car parking charges should be fair and proportionate; notes that some hospitals are still charging patients and their visitors excessive fees of up to £500 per week; further notes that the charity Bliss has said that parents with premature babies are having to pay on average £32 per week; further notes that for many patients it is essential that they travel to hospital by car; believes that such charges affect vulnerable patients at a very difficult time; and urges the Government to consider ways in which hospital car parking fees can be reduced.

Mitochondrial Replacement (Public Safety)

Fiona Bruce: I beg to move,
	That this House takes note of the Human Fertilisation and Embryology Authority’s most recent scientific review into the safety and efficacy of mitochondrial replacement techniques which highlights concerns for subsequent generations of children born through maternal spindle transfer and pronuclear transfer; welcomes the recent comments of scientists including Professor Lord Winston that, prior to the introduction of such techniques, more research ought to be undertaken and a full assessment conducted of the potential risk to children born as a result; and calls upon the Government, in light of these public safety concerns, to delay bringing forward regulations on mitochondrial replacement.
	I am pleased to move this motion and to have gained support from so many Members from across the House, and I thank the Backbench Business Committee for allowing us the time to debate it.
	It is in our interest as a nation to be at the cutting edge of technological progress. However, in striving for such progress, we cannot afford to cut corners when it comes to public safety. Surely this can nowhere be more true than in relation to the proposal that pronuclear transfer or PNT and maternal spindle transfer or MST be permitted in an attempt to create children who do not inherit mitochondrial disease. In 2011, 2013 and 2014, the Human Fertilisation and Embryology Authority or HFEA assessed the safety of the procedures, and on every occasion it reported that further research was required before the public could be satisfactorily reassured regarding them. It described experiments as “critical”, with some not even having started in June 2014. It stated that
	“there are still experiments that need to be completed before clinical treatment should be offered. The panel considers that some of these experiments are critical and others desirable.”
	Even more concerning, it stated, was that
	“the process cannot be expected to guarantee safety or efficacy when applied for the first time in a clinic.”
	In other words, to allow these procedures at present would be tantamount to experimentation.

Julian Huppert: Does the hon. Lady accept that when anything is tried on a human for the first time, we cannot be absolutely certain what will happen? Is she really saying that we should not do anything—no cancer treatment, nothing—until we are absolutely 100% certain that there are no side effects? Does she not accept that we are trying to treat hideous diseases?

Fiona Bruce: I accept that in no case can one be 100% sure that a technique will be safe. However, we are very far from that in this case. This is a case of genetic engineering; it is the alteration of a potential human being—the removal of certain genes and their replacement with others, to create children. Surely, in such cases, we should be very careful over safety before we proceed.

David Burrowes: I am grateful to my hon. Friend for securing this debate. It is not just her who has concerns about safety. When legislation was scrutinised in 2008, the right hon. Member for Bristol South (Dame Dawn Primarolo), now Madam
	Deputy Speaker, said as the responsible Minister that the safety of such techniques needed to be established before we could proceed.

Fiona Bruce: Absolutely. I thank my hon. Friend for his intervention.
	The HFEA has repeatedly told the Government that further research is required before we can proceed.

Andrew Miller: rose—

Lindsay Hoyle: Order. Nineteen Members wish to speak and other Members are trying to catch my eye to intervene. It is an important debate and we need to allow the allotted speakers in, so Members should think very hard before trying to intervene.

Fiona Bruce: Thank you, Mr Deputy Speaker.
	Parliament should be allowed to deliberate on and debate this issue at length, but that might not happen. I understand that the Government propose to lay regulations permitting PNT and MST before the end of this year. Sir John Tooke, president of the Academy of Medical Sciences has said:
	“Introducing regulations now will ensure that there is no avoidable delay in these treatments reaching affected families once there is sufficient evidence of safety and efficacy.”
	In other words, Parliament should vote blind and sign off legislation permitting these procedures before the recommended experiments—some of them critical, regarding safety—have been completed.

William Cash: As a veteran of these debates, going right back to 1985, I wish to commend my hon. Friend enormously for what she is saying and doing. There has been a history of manipulation, involving packing of committees, for example, over an extremely long period. My hon. Friend is right to take the line she is taking: it is not just about health and safety, but about the whole question of the ethical and moral values that lie behind attempts to manipulate genes. We all want to help people; the question is whether this is the right way to do it. I emphatically believe that it is not.

Fiona Bruce: I thank my hon. Friend for that intervention.
	Even more worrying than the quotes I have cited from the HFEA is the fact that many scientists, national and international, have gone further in publicly stating that these procedures should not be authorised at all—and not necessarily because they are against them in principle, as some are not against them. Stuart A. Newman, professor of cell biology and anatomy at New York medical college has described these proposals as “inherently unsafe”. Paul Knoepfler, an associate professor in the department of cell biology at the UC Davis school of medicine recently wrote that a process of this kind
	“could trigger all kinds of devastating problems that…might not manifest until you try to make a human being out of it. Then it’s too late.”

Tim Loughton: I am grateful to my hon. Friend and respect what she is saying. Safety is paramount, but for every year we delay bringing this science and technology forward, 6,500 children will pick up these horrible inherited diseases, and many
	of them will die. At what stage would my hon. Friend say that the risks of mitochondrial donation become proportionate to the severity of mitochondrial disease to which many of our constituents are subjected?

Fiona Bruce: I can respond in this way. In the general science, concerns have been referred to. A mismatch between nuclear and the mitochondrial DNA could cause severe health problems in children conceived with this technique: problems such as infertility, reduced growth, impaired learning, faster ageing and early death. Are those not sufficiently serious for us to be extremely concerned?

Guy Opperman: I support the work to combat this terrible disease, some of which is being pioneered by my local university, Newcastle, and I will be urging the Government to proceed with the trials, but the question is this. The new IVF technique that has been pioneered at Newcastle has proved to be successful in the laboratory, but the current law prevents it from being tested in a clinical trial or used in clinical practice. That is what we need to change. Without those clinical trials, we cannot progress and deal with this terrible disease.

Fiona Bruce: That is very interesting but the point I am making is that at the moment such clinical trials would involve children. Two peer-reviewed articles in Nature have suggested that mitochondrial transfer is inherently risky, one of them citing a figure of 52% of embryos created through MST having chromosomal abnormalities.

Jacob Rees-Mogg: There has been reference to the curing of disease but is that not a misleading way of putting it? What is happening is the creation of different people from those who would have been born suffering from the disease. Therefore, this is not curing an existing condition. It is stopping someone being born who would otherwise have been born.

Fiona Bruce: That is absolutely right. This technique will not provide a cure of mitochondrial disorders at all. Indeed, concern has been expressed that even where a female child born through the process appears not to suffer from the disease she could still be a carrier.

Several hon. Members: rose—

Fiona Bruce: I am beginning to think there may be a point at which I must not take any more interventions, simply because I know how many other Members wish to speak. I will not give way from now on. I would be delighted to, but I am aware that almost 20 Members have asked to speak in the debate.
	Professor Lord Winston, who supports the regulations in principle, has recently expressed concerns over public safety:
	“I don’t believe there has been enough work done to make sure mitochondrial replacement is truly safe. There probably needs to be a great deal more research in as many animal models as possible before it’s done.”

Huw Irranca-Davies: Will the hon. Lady give way?

Fiona Bruce: I will not give way again, as I said. Mr Deputy Speaker has asked me to limit my time quite severely in order that many other Members may contribute to this important debate.
	It is vital that, taking advice from scientists, the decision about whether to proceed down this road is made by this House and is seen to be made by the public. It would be wrong for Parliament to pre-emptively sign off the legislation even if there were a provision in the regulations saying that the Government would not move to implementation until such time as the HFEA said it was content with the outcome of the pre-clinical report. That would be to outsource the final decision to technocrats, possibly behind closed doors, rather than in the transparent environment of this Chamber, in full public view. Parliament cannot be seen to provide pre-emptive mandates in relation to a subject on which there are such significant public safety concerns. We need scientists and experts to conduct the research but we must make the final decision.
	I realise that you would like me to conclude, Mr Deputy Speaker. I will now do so with regret, because I would have liked to say a great deal more, particularly regarding the public concerns relating to the proposals. According to a ComRes poll, a limited number—only 18%—of the public are in favour of the proposals.

Several hon. Members: rose—

Lindsay Hoyle: Order. I will bring a four-minute limit in to give us a chance to maximise the number of speakers. If Members can cut the length of their speech, all the better.

Mary Glindon: I congratulate the hon. Member for Congleton (Fiona Bruce) on securing the debate.
	Members may not have heard of ovarian hyper-stimulation syndrome, or OHSS, as it receives little coverage in the media, but it is one of the most serious complications associated with the use of certain fertility drugs during the procedure known as controlled ovarian hyper-stimulation, which is a part of fertility treatment used to ensure that the number of eggs collected is as high as possible. OHSS is not uncommon—research suggests that as many as a third of women who undergo controlled hyper-stimulation experience some symptoms, although serious cases are relatively rare. Younger women, women with certain pre-existing health problems such as polycystic ovaries, and women who have had OHSS before, are particularly at risk. Severe cases of OHSS can be very dangerous and even life-threatening, with painful and debilitating symptoms. However, monitoring of cases of OHSS is far from adequate. In answer to a parliamentary question, the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), stated that
	“The HFEA does not…hold definitive data on the number of women admitted to hospital with OHSS, including non-patient egg donors and egg-share donors.”—[Official Report, 9 July 2014; Vol. 584, c. 313W.]

Jim Cunningham: Does my hon. Friend agree that it is probably necessary for the Government to bring proposals to the House for us to consider? There is not a lot of understanding about the disease outside the House and the public could be better informed, whichever way the decision goes.

Mary Glindon: I agree. There is probably not enough understanding within the House, either.
	The Minister had previously said:
	“licensed fertility clinics are only required to report instances of OHSS to the authority that require a hospital admission with a severe grading, although in practice clinics often report moderate OHSS as well.”—[Official Report, 24 June 2014; Vol. 583, c. 157W.]
	The figures that do exist indicate there has been a small recent increase both in the total number of recorded cases and in those cases categorised as “severe” rather than “moderate”. About 50,000 women go through IVF in the UK each year. The fact that we do not collect proper data on a potentially life-threatening condition that may affect a third of them, seems an astonishing oversight in the collection of official health statistics. Mandatory reporting of all cases is an essential first step in this process, but should only be the start of more effective and careful collection of statistics.
	This issue has a particular pertinence at present because of proposed changes to the law on mitochondrial transfer and the Government’s stated intention to allow the creation of three-parent embryos. I am sure that many Members may be struggling to get to grips with the details of this procedure, but simply put both of the techniques used in mitochondrial transfer require a significant supply of donor eggs. Any such eggs will have to come from women who have been through controlled ovarian hyper-stimulation, with all the attendant risks.

Martin Horwood: Will the hon. Lady give way?

Mary Glindon: I will not. Sorry. There is not time.
	It appears that very little consideration has been given to this fact in any of the various consultations and Government position papers that have emerged over the past two or three years. No in-depth questions about the physical health of women donating eggs were addressed in the HFEA’s own briefings. Will the Minister assure the House that she will take the matter back to her Department for consideration? In the light of the safety concerns we have heard today associated with the proposed techniques, such action would appear to be urgent, for the sake of the vulnerable women involved.

David Willetts: I appreciate this opportunity to speak from the Back Benches, perhaps for the first time in 20 years, so I apologise if I am a bit rusty. This is an important debate and I would like to comment briefly on the issue, drawing on my experience as Minister with responsibility for science.
	To put my cards on the table, I think that this is a great piece of British scientific advance. We should congratulate the scientists at Newcastle university who have been in the lead in the research. My view is that provided it meets stringent safety requirements this is something that should go ahead because it will alleviate the suffering of constituents whom we represent.

Huw Irranca-Davies: Will the right hon. Gentleman give way?

David Willetts: I will give way once.

Huw Irranca-Davies: I thank the right hon. Gentleman for kindly giving way and for his expertise in this area. It is of particular interest to my constituents Val Thomas of Cefn Cribwr and her sister Mrs Pitt, whose family have conditions that stem from mitochondrial deficiency. Does he agree that it is important to get accuracy in the record when we quote scientists, not least the correction that has been made by Lord Winston? He said this week to The Times:
	“This is a marvellous thing for people with diseases that are incredibly rare and that have terrible consequences.
	I am perfectly supportive of the regulations and I would vote for them.”

David Willetts: I confirm that my understanding is also that Lord Winston supports the advances in this area.
	The evidence is pretty clear that this could alleviate human suffering, but I am not a simple-minded believer that the consequences justify whatever we do. Looking at my hon. Friends assembled in the Chamber today, many may say, “All right, this alleviates mitochondrial disease, but the price—the threat to human dignity or integrity—is too great.” I should like briefly to touch on those types of objection.
	First, I do not agree with my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) that this somehow creates different people. We are not talking about the nuclear DNA that makes us who we are—the characteristics of our character or appearance. This is about a very distinctive part of DNA that has been called, for us laymen, a battery part of the cell, not the nuclear DNA, so it does not affect identity.

Jacob Rees-Mogg: Will my right hon. Friend give way?

David Willetts: I believe I can give way a second time.

Jacob Rees-Mogg: It changes 0.1%. If 0.1% is not a change, what percentage does my right hon. Friend think is a change?

David Willetts: It is a difference between quality and quantity. It is a change of 0% of the nuclear DNA that gives us our characteristics. It is a change in the membrane of the cell so that the battery function continues, but it does not affect human identity even by 0.1%. That is why I do not believe that there is an issue of dignity or integrity of the individual.
	There is an argument that this is an engagement with people’s ability to produce children that is reminiscent of some of the worst features of eugenics. In fact, in many respects it is the opposite of eugenics. Eugenics was about forced sterilisation. It was about saying to people who were thought to carry some disease, “We’re not going to allow you to have children.” This is the opposite. It is about saying to people, “We want you to be able to have children and to be able to do so free from the anxiety that they will be bearing some disease.” It is exactly the opposite of the parallel with eugenics that is sometimes claimed.
	That leads me on to the next objection. We are sometimes told, “Life is a vale of tears. There are sorrows and burdens that people have to bear, they should bear them with dignity, and this disease is part of that.” I have two responses to that argument. First, we have not run out of human frailties and problems yet. The problem facing our society is not yet that we have all started to lead lives of bland satisfaction.
	It is also important to recognise that these scientific advances create a new problem. For the first time, a parent—a mother—could know that she could transmit this disease to her child. We have learned something that we did not know before. If we allow people to have this knowledge but do not permit a medical intervention that will tackle the problem, we have created a new source of human suffering that did not exist before this scientific understanding came about. Now that this knowledge is available, failing to permit families to act on it would be an unacceptable addition of a new cruelty to what is already a very distressing condition. Therefore, in terms of our respect for human integrity and dignity, it is right to intervene.
	Then there is the argument that we are on a slippery slope. However, the framework set out in the Human Fertilisation and Embryology Act 2008 is very clear that we are not allowed to intervene in the nuclear DNA that shapes a child’s identity. That is recognised specifically as an exemption in the 2008 legislation.
	This is a scientific advance that does not affect human identity, that is the opposite of eugenics, that enables people to escape a potential new cruelty if we do not act on this knowledge, and that is not a slippery slope. This is not just my view. We conducted a structured dialogue to consult members of the public on what they thought. When they understand that this is not to do with hereditary characteristics being affected by an arrogant intervention to create a designer baby, they support these interventions. If they support them, then so should we, in all parts of the House.

Jim Dobbin: As a former NHS scientist, I would like to speak in support of the motion proposed by the hon. Member for Congleton (Fiona Bruce). Whatever our personal views on the ethics of mitochondrial transfer, it is remarkable from a procedural point of view that the Government are considering putting these regulations before the House before the critical pre-clinical tests by their own body, the Human Fertilisation and Embryology Authority, have been performed, written up and peer reviewed. I am not against research. I support scientific research, but scientific research that is safe. That is the situation in America, where this was put on the back burner basically because of the issue of safety.
	In my humble opinion, it is scientific practice to presume that tests will yield positive results. That has had the whiff of manipulating the evidence to fit the hypothesis. In this case, however, it is even worse, as the necessary evidence has yet to be produced. Such a methodology would not stand up in the scientific community, and if it is not good enough for the scientific community, it is not good enough for this House. We
	must wait for these results and examine them in detail. After all, we are talking about the possibility of permitting techniques which could be—I repeat, could be—disabling to the children who are created through them. As Members of Parliament elected by the people, we should be made fully aware of the risks and safety concerns surrounding these new techniques before voting on whether they should be allowed.
	There are three camps in this debate. There are those who oppose mitochondrial transfer for ethical reasons and those who are strongly in favour, but there is another group: those who are in favour but are concerned about safety. The votes of this third group will be determined by the available evidence. That evidence has not yet been produced. I am not talking about the more stringent evidence asked for by the world-renowned US Food and Drug Administration in its recent report on the subject, but the few tests that the Human Fertilisation and Embryology Authority—a clear and obvious supporter of the techniques—recommended as the critical bare minimum to be completed before progressing. We do not have the results of those tests. Does the Minister agree that it would be a subversion of due process to ask Parliament to vote pre-emptively on them?

Martin Horwood: Does the hon. Gentleman appreciate, though, that the HFEA’s expert panel is commending these techniques, and that if the regulations are passed, the responsibility for safely licensing each application will still rest with the HFEA, so the safety process will still be in place? This is a permissive step.

Jim Dobbin: I understand the hon. Gentleman’s point, but may I refer him to Dr David King, director of Human Genetics Alert? He is sympathetic to this process but fears that science is racing ahead of ethics. He says that we are in danger of creating designer eugenic babies, and we do not know where we are going in future.
	Denying Parliament the opportunity to examine these results seems difficult to defend. In effect, it would be asking the House to vote blind on the safety of techniques that the House might reject outright on the basis of the results. Let us be clear and honest about this: the results could not be published and peer reviewed in time for the rumoured vote in the autumn. I end with a clear and simple question to the Minister: do the Government intend to ask Parliament to vote on these regulations before the HFEA’s suggested critical tests are performed, written up and peer reviewed; and if so, why?

Tim Loughton: I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on introducing this debate. it is absolutely essential that Parliament has the opportunity to talk through these important details at greater length.
	As my hon. Friend knows, I am usually very conservative on ethical matters such as this. I do not usually advocate anything that might be seen as playing God. I have severe reservations about euthanasia. I have always opposed and will always oppose anything that would modify human characteristics and be seen as creating some form of designer baby. However, there are times when one has to be pragmatic. I have met families of the victims of these terrible, deforming, disfiguring and
	life-shortening diseases. It is right that we should use our human knowledge for the good of fellow mankind. It is great that, as my right hon. Friend the Member for Havant (Mr Willetts) has said, British science is leading the way.
	Science is about finding cures and solutions, and this is just a different way of preventing horrible things from happening to our children. It is fundamentally a human intervention and it should be judged purely on the basis of whether we are doing more good than bad. I believe that we are when one in 6,500 of our constituents each year contract, without any choice, these horrible inherited diseases. The longer we say, “We need more checks, more safety, more testing”, the longer we are delaying a cure.
	We need to get on with it. It has been widely consulted on. I have received virtually no letters on this matter and we need to take a balanced judgment on when the risks of mitochondrial donation become proportionate to the severity of the diseases that are affecting our constituents now. As colleagues have said, it will be licensed by the HFEA based on the safety and efficacy of the evidence, and those licences can be withdrawn at any time.
	“Mitochondrial donation only allows for unaltered nuclear DNA to be transferred to an egg or embryo that has unaltered healthy mitochondria. These techniques only replace, rather than alter, a small number of unhealthy genes in the ‘battery pack’ of the cells with healthy ones. Mitochondrial donation does not alter personal characteristics and traits of the person.”
	That is an important consideration, because:
	“Mitochondrial donation will enable mothers to choose to have children who are genetically related to them, with a natural combination of nuclear genes from both parents while being free from a potentially devastating disease.
	Nuclear DNA is not altered and so mitochondrial donation will not affect the child’s appearance, personality or any other features that make a person unique—it will simply allow the mitochondria to function normally and the child to be free of mitochondrial DNA disease. The healthy mitochondria will also be passed on to any children of women born using the technique”—
	so we are doing good for generations to come as well.

Steve Brine: I agree with what my hon. Friend is saying, and I do not agree with the motion of my hon. Friend the Member for Congleton (Fiona Bruce), although I have great respect for her, as a fellow Christian in this House. The work at Newcastle university is being funded by the Muscular Dystrophy Campaign and by the families and the people it supports and works with. Does my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) agree that the fact that they are putting money behind this, speaks volumes about the motives behind the work and about not letting the bad be the enemy of the good?

Tim Loughton: My hon. Friend is absolutely right and I think it is a great triumph that it is a British university that is doing this important work. To those who say, “No other country allows this sort of thing,” I say, “Well, great; we are pioneering here, as British science has done in so many different areas.”
	We need to be honest. We can raise a question about the ethics of it, but we should not hide behind safety considerations when certain people really oppose it for ethical reasons. Let us have that honest debate. I am prepared to give my support to these regulations and to
	us getting on with this science, with the assurances that there will be strict licensing conditions based on strong scientific evidence and that this in no way can lead to anything that can be remotely construed as designer babies, which I find completely and utterly abhorrent.
	We should get on with it. Mankind has used its knowledge and skill to invent some pretty devastating and ghastly ways of disfiguring, maiming, neutering and killing human kind. We should celebrate this remarkable advance in using our scientific knowledge—our human skills—for good, and potentially for the good of generations to come in the families afflicted with these terrible illnesses.

Frank Dobson: Mitochondrial disease is horrible. It has dreadful effects on children and shortens their lives and there is no cure. The scientists at Newcastle university have been trying to improve the inadequate treatment services that are presently available and one of the reasons why they got involved in this research is that they do not see very much progress there. The replacement technique does not provide a cure; it prevents the condition from arising in the first place, and generally speaking we all believe prevention is better than cure.
	There is no other option for these families and children. What is proposed would not be permitted under the law passed in 1990 and there has been consultation since 2003 about changes to the law, which led to the law being revised in 2008. That permitted progress to be made on this issue by regulation when the House decides that that should happen.
	Some people have fixed views and are totally against any embryo research and any changes to human fertility, and some other people want a total free-for-all. By and large, most of us do not want either of those things. The practical measures that were put in place through the HFEA have worked very well. They provide protection against the unprincipled and dangerous use of genetic science, and everything is subject to strict regulation. People are rightly concerned about the idea of designer babies and super-babies and the creation of a master race, but mitochondrial DNA replacement does not do that. All it does is eliminate one horrible life-threatening defect. It does not change personalities, and the baby we hope will be born will have a usual father and a usual mother—one mother and one father—and the idea that they will have three parents is ridiculous.
	Will it work? We do not know. There is a risk that it will not work. That is in the nature of science. In the earth-shattering paper produced by Crick and Watson in 1953, they were tentative and were not very sure about DNA, but they pressed on.
	Will it be safe? We cannot say for certain that it will be safe. There is always risk, but the risk will be taken only with the informed consent of the parents, and if people had always avoided risk in this sphere and if in 1968 at Oldham general hospital Robert Edwards, Patrick Steptoe and Jean Purdy had not taken risks with the agreement of Mr and Mrs Brown, the first test-tube baby in the world would not have been born and the whole world would be worse off as a result. If the scientists are willing to take the risks and keep them to a minimum and the parents are willing to take the risks and take the
	advice, we should put the HFEA in a position to regulate and permit this technique so that it can be used when it and it alone, is convinced that it is safe. That is why I oppose tonight’s motion.

Julian Huppert: It is pleasure to speak in this debate, and I pay tribute to the work of so many, but particularly the Lily Foundation and the Wellcome Trust who have done a huge amount to prepare for this debate, to educate the public, to support Members of Parliament and to support some of the research.
	I do not know, Mr Deputy Speaker, if you or others in this House have met people with serious mitochondrial disorders, but those disorders are absolutely awful. Cells fail to function, and people can get seizures, strokes, blindness, deafness, heart failure, lung failure and liver failure. Most of the people afflicted will not survive to adulthood. There is no treatment and no cure, and about 1 in 6,500 babies born will suffer from something like this. That is something I would hope everybody in this House would want to stop, and I simply do not understand how opponents of this can argue that they want to continue to inflict that sort of suffering on so many children, because that is the consequence of not finding a way to treat these disorders.
	The hon. Member for Congleton (Fiona Bruce) expressed concern that there may be consequences for people who are helped in this way. Her first example was, I think—I am sure she will correct me if I am wrong—lower fertility. Now, that is possible—we will not know until we try it on people—but if I had a choice between a hideous disease that was likely to kill me before adulthood or the possibility of lower fertility, I know which one I would choose.
	We also heard the comparison to eugenics. This is fundamentally different. Mitochondrial DNA is very different from nuclear DNA. It has a very different history, and it is a fascinating history—I used to work on mitochondrial DNA and other nucleic acids so I have some interest in this. This is not the same as eugenics, as the right hon. Member for Havant (Mr Willetts) explained well—it is good to have him in the Chamber, even if he is not in his former place.
	We have heard arguments about multiple parents and the idea that this approach means that somehow there are three parents, but there are clearly two parents. I have not heard people say that if someone is given an organ donation and they have someone else’s organ inside them, they then have four parents because they have a lot of different DNA inside them which could interact. I think—I would hope—that all of us support organ donation, because it has saved many, many lives. Why should we not allow what is, in effect, mitochondrial donation?
	We have heard the view that we should wait for there to be much greater safety. My mother had breast cancer a couple of years ago and she wanted to choose which of the two most modern treatments she should have. She wanted to know what the life expectancy was and whether she would live for 15 more years with either treatment. The answer was, of course, that we do not
	know, because with the most modern treatments we have not waited 15 years to find out. But I do not think any of us would say that we should not use any single cancer treatment that has been used this century because we do not know whether someone will live for 15 years after having it.

Graham Stringer: I agree completely with what the hon. Gentleman is saying. Does he agree that the motion would be better if it was asking for these enabling regulations to be hurried up? They will take into account, as much as one can, all the safety issues, and by delaying them we may be condemning more children to horrible diseases that could be prevented if we hurried this process up.

Julian Huppert: The hon. Gentleman is absolutely right, but I would improve the motion in a number of ways. I would not try to characterise Lord Winston’s position as being fundamentally different from what it is. I would also say that we need to have these regulations so that the tests can be done and so that we can go ahead with clinical trials and find out what happens in humans. I hope that the Government will introduce the regulations promptly. It has been useful to have this airing of views, but it will be helpful when we have the regulations before us to have that debate. This House will then be able to vote on whether or not to adopt the regulations.

Lady Hermon: May I assume—I am sure I am right in doing so—that this technique has already been trialled on mice and that the hon. Gentleman will know whether those trials have been successful? It would help the House if he could enlighten us about the success or otherwise of using this technique on mice.

Julian Huppert: I do not have a list of the organisms it has been tested on, but it has been widely tested on a number of organisms—I assume that mice are one, but I could not be absolutely certain—and has been successful. Obviously, if it was not successful on any other organism, it would be perverse to want to go ahead with it. However, I do not have details on the experiments with me.
	I understand and appreciate that some people have genuine religious or ethical objections about interfering with an embryo. They are entirely welcome to make that case, but they should not claim other reasons as a cover for that. People are welcome to their ethical opinions—that is fine—but to say that we should not do this because we should wait indefinitely for more and more tests, so that we can be more and more sure before we ever try it in a human is simply to condemn more children to more pain and more anguish. That is not the right way to go. We do need to do more tests; there is much more to do before this will become a regular thing on the NHS and people can be saved—there is no doubt about that. But for that to happen, it has to be tested in humans—it has to be tested in children. We will help at that point, and I hope we will have children who do not have the sort of hideous problems we see now. I urge the Government to get on with this. We have to reduce the number of children who have these hideous conditions. The Government have the chance to reduce it and they should act promptly.

Robert Flello: I thank the hon. Member for Congleton (Fiona Bruce) for securing this important debate. Some in this House are in favour of the treatment and oppose the motion, whereas others, like me, support the motion and oppose the procedure. The important thing is to have the debate and to put down a marker, and I hope that the Government do not try to rush these things through, as I believe they originally intended.

Frank Dobson: Consultation on this started in 2003. If this is a rush, how would my hon. Friend describe something that was slow?

Robert Flello: I am grateful to my right hon. Friend for that. I have been in this House since 2005 and this is the first debate I have had here on this matter, even though the consultation may have started in 2003. I will return to the issue of the consultation shortly, if I am able to do so in the four minutes and 10 seconds remaining to me.
	There is no doubt that this disease affects many children—I believe the figure is one in 6,500—and has some horrendous and devastating consequences. However, the chief medical officer seems to believe that perhaps 10 lives a year might be changed as a result of this treatment. That is absolutely important for the 10 people involved and their families, but my understanding of the science is that it is very hard for the researchers to know who those 10 people might be and how to decide which children might benefit and which might not.
	I agree with a number of speakers who say that two issues are involved here. I have grave concerns about this from not only a moral, ethical point of view, but a public safety point of view. Whatever someone’s position on mitochondrial transfer, I am sure we must all agree that we cannot authorise new research techniques that are unsafe or might be unsafe. In this context “unsafe” does not only mean that procedures may not work; it means that they may result in disabilities and illnesses. To put it crudely, there is every possibility that we could be legislating to allow techniques that could cause damaged embryos, resulting in further damaged children. That is not spin; it is a reasonable assumption based on the available data. Newcastle university’s own paper concluded that, compared with control experiments, 50% fewer eggs fertilised through pronuclear transfer reached the blastocyst stage—in other words, pronuclear transfer is twice as likely to cause the embryos to fail. No further work was conducted on why so many of these embryos developed abnormally, despite consistent calls from concerned scientists.
	Based on the available data, therefore, we cannot rule out the possibility that these techniques could cause the people born as a result to have illnesses or disabilities. The Government have a responsibility, as we all do, to avoid such eventualities, and we cannot take that lightly. We might not know the result for many generations. We might not know whether some damaged has been caused until three, four or five generations later. We simply cannot know that. Indeed, in a conversation I had with an hon. Friend in this House not a few hours ago there was talk of how science is about probabilities and risk; it is not fact but about what may or may not happen.

Steve Brine: I am listening carefully to what the hon. Gentleman says, and the way in which this debate is being conducted shows the House of Commons at its best. He is one of the co-sponsors of this debate and he is speaking out of a great deal of fear about what might happen. Is his wish, in supporting the motion, to kick this into the longest of long grass or to see it stopped dead in its tracks? Will he be clear about that?

Robert Flello: I can be even clearer than that, because it is neither of those things. I want further research done on the safety implications and I want the consultation to which my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) referred a while ago actually to be taken forward. Let us consider the polling the Government did. Their response to the consultation on mitochondrial transfer, published the day before the summer recess, tells us that
	“700 expressed general support for the regulations and 1,152 opposed the introduction of the regulations with the remainder not expressing a view either way.”
	Yet the same day the BBC quoted the Department of Health as saying:
	“A public review into the three person IVF technique has been broadly supportive”.
	That in turn enabled Dr Jeremy Farrar, director of the Wellcome Trust, to say:
	“As the Government’s latest consultation has again shown, there is broad public support for making mitochondrial replacement therapy available to patients”.
	That raises the question: in which world does 1,152 against and 700 in favour equate to “broadly supportive”? Does the Minister support her Department’s briefing that the consultation responses were “broadly supportive”? What further action does she intend to take to correct the highly misleading statement? Someone may think that the public were misinformed or that only a small group of people were responding and the responses were thus disrupted, but what is the point of having that consultation if no notice is going to be taken of it?
	At the end of the day, there is concern about this matter. I have a concern—perhaps I am the only Member in this House who does—but if, as I fear, this legislation goes ahead in the autumn, I do not want to have to come back to this House to say to future generations, “Look what we did.” Once we go down this route and children start being born, there will be no turning back—[Interruption.] Yes, it is the power sell of the cell. There is not enough research on what the mitochondrial part does. Is it just a battery pack, or is it more? We just do not know. I do not want to have to stand up in this House and explain to generations of future children why we let them down.

Paul Beresford: Perhaps I could turn the last comment the other way round. I do not want to be standing here, or sitting at home in my dotage, saying, “Why didn’t we do something when we could have?” That is what we are looking at. We have the same problems with many issues relating to human fertilisation and embryos. We have heard these arguments in the House before. We have heard the speculation and the unsupported fears. Although I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on raising this debate, the scares that she raised are as
	unsupported as anything we have ever heard. I also congratulate my right hon. Friend the Member for Havant (Mr Willetts) on his contribution. He saved us an enormous amount of time because he covered the key points and nailed them to the floor. The right hon. Member for Holborn and St Pancras (Frank Dobson) reminded us just how long we have been examining this issue. Action is now overdue. I will now completely ruin the political career of the hon. Member for Cambridge (Dr Huppert) and say that I support him.
	Today, we are talking about a real opportunity to help thousands of children by taking out of the system, over time, an inherited condition. We are talking about a gene transfer through nuclei, and the 0.1% that was mentioned is motor functional; it is not inherited genes. It is an opportunity to have two parents and not, as the media would have it, three parents.
	The media has to take some of the blame. We have discussed these complex issues of fertilisation and embryos and so on, and the scaremongering has been appalling. There is scaremongering not only by individuals—I am not necessarily talking about the ones who write in green ink—but by the media. I was shocked to hear this nonsense about three-parent babies, on which the hon. Member for Cambridge touched. We are not talking about three-parent babies. This is an opportunity to put through these regulations. We are a bit early because we have not yet seen them or the results of the consultation. We have not even seen the Government’s reaction to them. None of us here—not even the hon. Member for Heywood and Middleton (Jim Dobbin) who spoke about the American situation—knows what will happen or is an expert on the matter. None the less there are experts who are reviewing this and coming forward with recommendations. They know and understand the subject a lot better than we do. We have to take their guidance and expertise. By the way, a comment was made about the Americans putting this matter on the backburner, but that was a different situation from what is under discussion now.

Steven Baker: My hon. Friend is making his argument with characteristic force. I am just mindful that when I read the Library brief, there was a particular insight from an evolutionary biologist suggesting that there was a real danger of DNA mismatching between the mitochondrial DNA and the nuclear DNA. Is he satisfied that the insights of evolutionary biology have been fully and adequately taken into account in this area?

Paul Beresford: If my hon. Friend looks at the research, I think he will find that that will have been looked at. From my limited knowledge—my knowledge is limited but it may be slightly greater than that of my hon. Friend—I suspect that such a mismatch would mean that the nucleus and the cytoplasm with the mitochondria would fail and an ovum would not be produced from it, but I could be wrong. I am speculating in the same way as my hon. Friend did. At the end of the day, we have an opportunity to change the rules to allow this research to progress. We must recognise that we have some of the best teams in this field in the world. We lead the field, and this provides us with an opportunity
	to continue to lead for the benefit of those many children. It will enable us carefully to continue with the research with the appropriate safety factors built in, so I am adamantly opposed to the motion.

Several hon. Members: rose—

Eleanor Laing: Order. Before I call the next Member to speak, I should point out that although we have a four-minute time limit, it has been a lively debate with many interventions, so most people have taken five or six minutes. I will now have to reduce the time limit to three minutes.

Alex Cunningham: I want to tell the story of a Stockton family with a vested interest in what happens in this Chamber today.
	Baby Jessica Newall was carried into my advice surgery by my constituent and her uncle, Martin Holliday. He put her pram seat on the table and we were introduced. Jessica looked like any other young baby: pretty in pink and seemingly content. If it had not been for the feeding tube disappearing into her nose, I would never have known that there was anything amiss. She brought her mum, Victoria, and her grandparents. They were there to win my support for mitochondrial replacement technique, which would help ensure that everything possible was done to minimise the possibility of a baby being born with faulty mitochondria and having to suffer as I am sure Jessica does.
	I listened carefully to Jessica’s mum who very calmly and with great personal strength told me Jessica’s story. Jessica will not live much longer—perhaps only a year or two. She cannot be fed naturally and relies on a feeding tube. Her body will not develop, which means that she will not grow and her internal organs will deteriorate. She cannot communicate like other babies. Perhaps worst of all, Jessica often wakes up screaming in terror and there is nothing her parents can do but hug her and comfort her.
	Victoria told me that there is no cure or treatment. She went on to tell me about what she saw as the answer for giving women like her a chance to have a baby without the substantial risk of that baby suffering from the disease. I know that we cannot make decisions on the basis of emotion, and yes, Jessica’s story is heartbreaking and charged with emotion that would affect any caring person, but it is also an accurate factual story demonstrating the devastation that mitochondrial DNA diseases can cause. That demands action from Ministers and this House of Commons.
	We also need that positive action for many other reasons too. Even in less severe cases, mitochondrial disease can have an overwhelming impact on families, and the Government’s consultation recognises the
	“painful, debilitating and disabling suffering, long-term ill-health and low quality of life”
	that all too often result.
	The north-east England Stem Cell Institute described these disorders as
	“a cruel class of inherited disease, because serious, even life threatening conditions are coupled with great unpredictability about how future children will be affected.”
	There is no cure, but there has been lots of research and we have seen some progress in this area. It is an inescapable fact that medical advances such as these will trigger ethical conundrums and challenge us actively to consider how we perceive the sanctity of life. I agree that there are safety issues. This is not without risk, but if we are to avoid this horrific suffering in the future, we need the regulations now to make the necessary progress and help ensure that we do not have more babies like Jessica.

David Burrowes: It is a pleasure to follow the hon. Member for Stockton North (Alex Cunningham) who gave us that moving account of Jessica. That account has also raised other matters in relation to the principles and the ethics of the issues with which we are dealing. In 2008, I was involved in the scrutiny of the Human Fertilisation and Embryology Bill and the Joint Committee and I still bear the scars. We are focusing here on public safety. We are not doing that as a guise, as some hon. Members have wrongly suggested. The focus is on safety, because that is what Parliament intended to be the case. We need to be absolutely satisfied about the safety of the process. Concerns over the painful, debilitating, serious mitochondrial diseases have been well made, but we must consider safety.
	The hon. Member for Cambridge (Dr Huppert) says that we need an honest debate. He quoted Lord Winston, who said—the Government need to take heed of this when they seek to make some redefinitions—that mitochondrial transfer is genetic modification, and that modification is handed down the generations. Lord Winston said that it was totally wrong to compare it with a blood transfusion or a transplant and that an honest statement might be more sensible and encourage public trust.
	The point is that Parliament intended to proceed cautiously and not in the permissive way suggested by some in 2008 who said that we did not need regulations and should just let the HFEA get on with it. The idea was that the question needed to be explored carefully. The Minister at the time, the right hon. Member for Bristol South (Dame Dawn Primarolo), said:
	“there are so many questions that we cannot yet answer, the Bill provides for the principle…They can be drafted only when the research is at a more advanced stage.”
	That deals with why this has taken so long, as the research was not at a stage to allow the regulations even to be drafted. We must also take heed of the fact that the then Minister also said:
	“The Bill provides the flexibility for further consideration by the public and Parliament, and for the specific details of the techniques to be specified in regulations.”
	That is where we supposedly are now. She went on:
	“More importantly, the Bill allows that once the safety of the technique is established and not before.”––[Official Report, Human Fertilisation and Embryology Public Bill Committee, 3 June 2008; c. 25.]
	That was the intention of the Minister at the time and I hope that it is the Minister’s intention now.

John Glen: My hon. Friend is making a thoughtful and powerful case. My concern is that if the implications are not fully understood, instead of
	dealing with the legitimate concerns of all the parents of children who are suffering greatly, we risk creating even worse conditions in future generations.

David Burrowes: My hon. Friend makes an important point. We recognise that this is not an uncontroversial technique similar to blood transfusion. It is controversial, and we must recognise that if we want to bring the public along with us. We must also recognise that, as my right hon. Friend the Member for Havant (Mr Willetts) said, we would be leading the way in scientific advancement, but we would be leading the way not just because of scientific development but because other countries had considered the ethics, complications and risks and said that they were not going to go down that route. Some might say that we are out there at the forefront, but others might say that we are out there on a limb.
	On 22 July, the Minister responded to the consultation by saying:
	“We wanted everybody with a view on the regulations to comment and the majority of people were positive.”
	We have heard from the hon. Member for Stoke-on-Trent South (Robert Flello) that there is another view. The Minister went on:
	“We will now progress with our plans.”
	Given that I was present during the scrutiny of the Human Fertilisation and Embryology Bill, I would suggest that the then Government—I had much against them as regards the Bill—clearly intended that safety must come first. The issue is not whether the majority want it or who has the loudest voice—scientific or otherwise—but about safety. We need to be convinced so we must take heed of the HFEA, which says that although we have had the detailed submissions:
	“Let us be clear: safety is and will always be of paramount importance...progress being made towards safety in this area”.
	Progress is being made towards safety, but we are not there yet. The HFEA agrees that further research is needed. Pre-clinical data and research need to be considered, and that must all happen before we progress further. I urge the Minister to take heed of the concerns and to proceed only after we are clear about safety. We are not there yet.

Ian Paisley Jnr: Those who have spoken against the motion have said that they want people to be honest and that they want the truth, but when they have bandied around quotations from Lord Winston they have obscured the truth. Lord Winston’s position is clear, and he is for this type of research, but he made one thing abundantly plain. He said that this
	“is genetic modification and is handed down the generations.”
	He was honest and called it what it is. He went on to say:
	“It is totally wrong to compare it with a blood transfusion or a transplant and an honest statement might be more sensible and encourage public trust.”
	We have such anger and confusion about the issue because of that deliberate deceit and dishonesty, and the House should take cognisance of that.
	The other tactic that has been deployed is to felon set, to emotionally blackmail and to say to people such as the hon. Member for Congleton (Fiona Bruce), “You have inflicted”—these are the words used about her by the hon. Member for Cambridge (Dr Huppert)—

Julian Huppert: indicated dissent.

Ian Paisley Jnr: Yes, you did. Check Hansard. You said, “You have inflicted this disease on people.”
	The debate has got very personal—it has gone into that realm—and people are trying to felon set, to emotionally blackmail, to emotionally charge the debate and to say that people are, to quote another Member, scaring us into opposing this. We must be abundantly clear that such emotional blackmail should be removed from the debate. There should be an honest debate and we should be allowed to discuss the ethics and to put on the table our views, including our moral views.

Margaret Ritchie: Does the hon. Gentleman agree that the complete lack of evidence on the possible outcomes as these children grow up and have their own children, with females passing on their genetic code to children, means that the technique should not be proceeded with at this stage?

Ian Paisley Jnr: Some of the pre-clinical tests were completed only in June. It is impossible even to read the detail of them, yet we have a mad rush from some people to proceed. I am not standing in the way of that, but saying that we should do so on the basis of solid, sure and grounded evidence, not emotional blackmail and emotionally charged arguments. The evidence therefore becomes critical. We should be allowed to consider it and we should allow the evidence to emerge post-pre-clinical testing and examination.
	There have been two public consultations and I heard one Member dismissing them, saying that all the letters were the same. I can tell the House this: if the letters had all been the same and the majority view had been the other way, the same Member would not have been saying that tonight. He would be saying, “Oh look, the public are with us. The consultation’s there.” The Department of Health consultation is against this proposal and so is the consultation by the HFEA. The ComRes polling moved dramatically between February and August from a wafer-thin majority of 35% of people in favour of the proposal to an overwhelming majority of 55% or so opposed to it. That is a huge landslide.
	Honesty should return into the centre of the debate and we should have a full, frank discussion. Let me be clear about my position, as people will ask about the ethical position. I come from a moral stance. I share the psalmist’s view that we are “fearfully and wonderfully made”. We should stand in awe of that and praise the great creator for it, but that should not preclude us from having a proper debate. Other Members have mentioned colleagues or constituents who have had children brought in front of them and I, too, have a constituent who wheeled a little child in front of me. Her words ring in my ears today. Despite all the hurt, all the heartache and all the pressure, tears and anguish for that family, the words of the mother were very clear, “Ian, I would not change this for one moment.”

Edward Leigh: There has been a great deal of controversy over the past few decades about genetically modified plants and crops. Through the march of applied sciences and advances in agriculture we have managed to feed billions of people,
	but I am sure that all Members will agree that we are dealing with entirely separate issues when we talk about genetically modified food and what we are dealing with now, which is genetically modified people. We have only in the past 100 years come to terms with the debilitating, restrictive and oppressive results of centuries of racism buttressed by pseudo-scientific notions that have since been proved entirely false. How much more of a problem will we be confronted with when humanity is divided between the modified and the unmodified?
	I say to my right hon. Friend the Member for Havant (Mr Willetts) that mitochondria contain DNA. They are present in every cell in the body and just because they are not nuclear does not mean that they are any less an integral part of a human being. The mitochondria that contain DNA interact with the nucleus and many scientists therefore believe that they contribute material to the identity of an individual. Bioethicists have up until this point expressed almost universal consensus on germ-line genetic modification of our fellow humans, rejecting it as grievously immoral and completely unethical. The consensus is worth pointing out as we must know what the proponents of mitochondrial transfer are asking us to dissent from. They are asking us to dissent from opinion in every other country in the world. In this age of globalisation, we will be divorcing ourselves from the entire community of nations in terms of bioethics. Do we really want to become a rogue state in terms of bioethics?
	No one can deny the debilitations and hardships that these diseases cause. No one is seeking to downplay that suffering, but this is not about a cure. This will neither heal nor cure a single human being suffering from these diseases. What is worse, when we talk about pronuclear transfer, is that that effectively requires the creation of human beings for the sole purpose of harvesting their useful parts. Is that really the sort of society in which we wish to live, in which persons—individuals—are created, their parts harvested and then destroyed, merely to provide for other human beings? There is no way that that can be considered ethical, whether in terms of purely rational deductive natural law, or by the system of Christian ethics on which we in this country have traditionally relied. I hope hon. Members on both sides of the House, and from every part of the spectrum from right to left, can unite on that point. I support the motion.

Chi Onwurah: I am proud that in Newcastle upon Tyne Central, my constituency, Newcastle university has pioneered research into variations on IVF treatments and procedures that can prevent the transmission of the genetic mutations that cause those devastating disorders. We also have victims of that devastating disease in Newcastle, such as Lily Cass, who is in her 70s. Some days she can hardly move due to a lack of energy caused by her faulty mitochondria. It takes all her strength away. She has four children, including a daughter, who is likely to pass the disease on to her children. She worries about that all the time. For those women and their families, the most important help we can offer are those potential treatments.
	I want to focus on the so-called three parents issue. The embryo would carry just 13 out of 23,000, or 0.056%, of the genetic material from the mitochondrial donor. As the right hon. Member for Havant (Mr Willetts) said, it is not the nuclear DNA, so the child’s appearance,
	personality and other features are not affected. In Britain, the egg donation and surrogacy principle, whereby more than two parents can contribute biologically to the birth of a child, is already recognised. Medical procedures that introduce a donor’s biological material are also long accepted. The headlines, such as the BBC’s recent “Mum plus dad plus mum”, are not only sloppy and sensational, but unscientific. I would like the BBC’s other programme, “More or Less”, to comment on whether giving 0.056% of genetic material and 0% of nuclear DNA really constitutes being called “mum”.
	The UK is carrying out pioneering research on mitochondrial diseases. This country has the opportunity to be at the leading edge of the world in preventing such terrible diseases. It has taken us years to get to this point. Never before has a technique had such rigorous investigation, and ethical and scientific analysis. It is therefore incredibly important that progress does not stall.

Heather Wheeler: Like other hon. Members, a constituent, Clare Exton from Newhall, came to talk to me about this issue. She is a vibrant lady and was on a mission. As a listening, caring MP, I was happy to listen to her story. She spoke to me about the charity work she does, the self-help group people have built up together, and the social functions they perform in giving one another support at such a difficult time. She was the one who first told me about how tantalisingly close the opportunities for the new science were.
	I admire my hon. Friend the Member for Congleton (Fiona Bruce) so much—she is a lady of such high moral standards and ethics that it almost pains me to tell her that I cannot support her motion—but the big prize is the new science we have heard about. The arrangements that the HFEA will put in place so that there will be no doubt whatever that the science is telling us the truth are massively and incredibly important.
	I believe that this is a time in science and in the Chamber at which we ought to do the right thing. I have absolutely no desire to annoy any of my friends who have truly, deeply held religious feelings, because I think that, if they were shown this in black and white, they would still not agree. That is fine—of course it is—but we are making our constituents suffer, and it carries on year after year. It does not need to be like that. I am sure the Minister will describe the safeguards. That is all I want to say. I believe that our constituents deserve this chance.

Andrew Miller: This is a fascinating debate. I should like to place on the record a definition that has not been used:
	“Mitochondrial donation is a fundamentally humanitarian intervention designed to help people affected by a devastating disease to fulfil one of the most basic human aspirations: to have a healthy family.”
	Regrettably, I cannot claim copyright on that, because it belongs to the Wellcome Trust, so one of the pre-eminent organisations on scientific research in this country very much supports the regulations that will come into force.
	It is a pity that the debate is polarised because of the different views on the ethics of intervention. Although
	it is legitimate to explore the ethical issues, one should do so without misusing the scientific evidence. I fear that that is what is happening.
	It is clear that safety is at the heart of the proposals. The hon. Member for Congleton (Fiona Bruce) referred to the HFEA. When we pass the regulations, safety will remain of paramount importance, as it always has been. The technique has received unprecedented scrutiny by the HFEA’s specially convened expert review panel. Never before has a new medical technology been subjected to such thorough investigation—my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) described the history.
	It is clear that, if Parliament passes the regulations, it will not immediately become possible for clinics to treat patients using those techniques. When the regulations are passed, responsibility will pass to the HFEA, which will decide, based on safety and efficacy evidence, whether or not to license individual applications for use. That tried and tested process has been used over a number of years. My point is that we decide the ethics, and the HFEA determines the specific use.
	Nothing is being rushed. We have been going on for such a long time, but time is precious—it is precious to those potential parents. Let us not waste time today, and let us reject the motion.

Sarah Wollaston: I rise to urge the Minister not to delay bringing forward the regulations, and I urge the House not to lose sight of the children and their families who are devastated by mitochondrial diseases. Of course it is absolutely right that the House debates the ethics, as so many Members have pointed out, but at times the language used has clouded those arguments. We have heard terms such as “eugenics”, “three-parent babies”, “designer babies”. This is not about wanting to create a child who is more beautiful or more intelligent. This is about wanting to spare families and children from a lifetime of devastating medical problems. We have the potential to do that. I fully respect those who oppose this on ethical grounds—they are entirely consistent in their view—but I am concerned that there has been selective misquoting from the scientific evidence. The House is not really qualified to examine the evidence in detail, and that is why we have expert panels, and bodies such as the HFEA, to advise and regulate this, and they do so with a great deal of thoughtfulness and expertise.
	We have to be clear that the third scientific review, the expert panel, which I regret has been selectively misquoted, has looked at that evidence and has concluded that it does not show that the technique is unsafe. We will not know whether the technique is effective until we allow trials in a human context—it may be that there are complications; we have to be honest about that, and we have to be honest that this is not the same as a blood transfusion—but we do know absolutely for certain that families and children are suffering now from these diseases. That is why, on the balance of the safety issues and the advice from the expert panels, we should not reject this on safety grounds.
	The point made by the hon. Member for North Antrim (Ian Paisley) about the child sitting in front of him in his surgery whose parents would not change that child was particularly powerful. No one is asking to
	change a child. What we are asking is for future generations of children to be spared that part of them that creates the suffering, but to keep within them all the personality and everything else in their genetic make-up that makes them who they are.
	I am also concerned to point out that if I were to donate my mitochondrial—

Eleanor Laing: Order.

Madeleine Moon: I rise to speak only on behalf of my constituent Margaret Evans. Margaret was unfortunately forced to move into Picton Court care home in my constituency. I was contacted by her sisters, Val Thomas and Mrs Pitt, who live in the constituency of my hon. Friend the Member for Ogmore (Huw Irranca-Davies), who asked me to meet Margaret to see how mitochondrial disease affects their family. They talked to me about four generations of women who have suffered massive disfigurements. Often they are unable to move their heads because of huge growths in their necks, which require surgery to remove them. Often they are unable to move limbs because the limbs give way and the energy is not there to do so. Breathing can be difficult. The human cost, the human suffering, the disfigurement they experience is horrific.
	What affected me most was Margaret Evans telling me that her young daughter, aged seven, is already saying, “Mum, will I end up like that? Am I going to have to suffer this? Will this happen to me?” No child should have to ask such questions when we in this House have the opportunity to change their future to one that will not include suffering, pain and disfigurement. I urge that we move this forward. Let us make a decision. Let us be brave. Let us give an opportunity, a chance of hope, to these families.

Jim Shannon: We have heard many stories today about the potential of mitochondrial replacement for women with mitochondrial conditions, possibly allowing them to have children without these conditions. But the hon. Member for Congleton (Fiona Bruce) and others have put forward the safety issue and the need to make sure that there has been a full investigation. This might seem like fantastic news, but just because the HFEA expert panel has not found evidence to say that mitochondrial transfer is unsafe does not amount to saying that the evidence proves it is safe either, as the potential risks of the techniques required are not yet fully understood.
	The controversy surrounding genetically modified food comes to mind: it teaches us a number of important lessons. In a paper submitted to the “Science as Culture” conference in 2008, several academics asserted that
	“the GM experience represents a warning, a cautionary tale of how not to assess an emerging technology and allay public concern.”
	Clearly, there is some evidence to show that we need to look at this again.
	The UK is the only country that is considering permitting these techniques. In the USA, the Food and Drug Administration held hearings where concerns about the
	safety of the techniques were explored. Some even consider the lack of international consensus as a sign that the UK is moving too quickly, and I must admit that I, along with many others, share that view.
	The Government have sought to justify ignoring the clear majority against the techniques on the basis that respondents to public consultations are from self-selecting audiences, but I say to the Government, “Ignore them at your peril.” It would be foolish to dismiss responses to public consultations on any subject in such a cavalier manner, but when we are dealing with concerns regarding the public safety of what is in effect a new biotechnology, and when the memory of the GM food debacle is still fresh in the public memory, the strategy is exceptionally foolish.
	It is important that we consider these matters in their full detail. It is in this regard—mindful of the need to avoid at all costs any sense of rushing and of ignoring public opinion post the GM food saga—that difficulties surrounding the approach of the Department of Health are thrown into particularly sharp relief.
	According to a poll conducted by ComRes in February, 35% supported the technique and 34% were against it, but in a matter of six months those figures changed to 18% in support and 46% against. That extraordinary loss of support in a very short period highlights that the cavalier approach of the Department of Health is very risky and dangerous.
	At the very least, the Government should reassure the public by making it absolutely plain that they will not rush into laying any regulations before this House or anywhere else until all the pre-clinical experiments recommended by the HFEA in its three safety reports to the Secretary of State have been concluded. Only then will we be able to move forward.

Andrew Gwynne: May I first place on the record my thanks to the hon. Member for Congleton (Fiona Bruce) and the other sponsors of this debate for securing the time from the Backbench Business Committee to ensure that the House can discuss such an important issue? I also hope that my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) will get well soon: she should have been closing this debate on behalf of the Opposition, but unfortunately she is not well today. Some people have greatness thrust upon them and I have had to do two Back-Bench business debates this afternoon.
	I also thank all hon. and right hon. Members for their contributions throughout the 90 minutes that we have had to discuss this very important issue. We have had no fewer than 19 Back-Bench contributions, which have all been of incredible quality. The impassioned and thoughtful considerations we have heard are a testament to what a sensitive and complex matter this is. As my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) said, it is important that we have this debate, wherever one comes from and wherever one arrives at, and that the House of Commons discusses these issues.
	On the one hand, we have celebrated the triumph of science that these new techniques represent. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), the hon. Member for Hexham (Guy Opperman) and the right hon. Member for Havant
	(Mr Willetts) have said, it is thanks to years of pioneering research at the university of Newcastle into how we can prevent the transmission of genetic mutations that we are finally reaching the point at which we can consider using these transformative techniques in humans. We have within our reach the possibility of eradicating mitochondrial disease from families who have been blighted by it for generations—families who have endured a disease for which there is no cure, who have suffered daily battles with painfully debilitating symptoms and who have lost their children prematurely.

Glyn Davies: Does the hon. Gentleman accept that those of us who remain uncertain about the proposals share the exact same concern as those who support them about those who suffer from mitochondrial disease? That should never be forgotten: the concern of those of us who are uncertain about the proposals is every bit as great.

Andrew Gwynne: I absolutely agree. I have to say that I do not often agree with the hon. Member for Cambridge (Dr Huppert), but he made the very important point—one of many in his speech—that whether people are coming from a scientific perspective or a religious one, their views are equally important in this debate. I am very glad that both sides of this debate have been able to air their views.
	Of course, families have had to face up to the risk—perhaps the certainty—that to be a parent will come at the expense of a difficult and, in too many cases, painful life for their children. On the other hand, we have grappled with the undoubted ethical and moral questions raised by the proposed introduction of such techniques. Some hon. Members have shared their anxiety about the uncharted territory we are now in, but that has been good for the public debate. Indeed, the proposed regulations would make Britain the first country to legalise mitochondrial transfer, and scientists have acknowledged that there will always have to be a leap of faith when the technique is first used.
	It is important that all these arguments are debated at length and given full and proper consideration, but it is also critical for the integrity of the eventual decision that the debate should be based on the facts. When debating such matters, we will naturally hear a number of contradictory assertions. I hope that the Minister can reassure the House about some of those issues we have discussed.
	The first concern raised is that the process has been rushed through. Anybody involved in the development of the techniques would disagree that this has moved quickly. Indeed, my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out that the consultation on the process began in 2003. It was more than six years ago—back in 2008—that the Human Fertilisation and Embryology Act 1990 was amended to introduce powers to allow regulations to be brought forward to enable mitochondria replacement to take place. It was back in 2010 that researchers at the university of Newcastle developed the techniques to avoid diseased mitochondria being passed from a mother to her children, and it was not until after another three years of consultation and review processes that the Government announced in July that they would introduce regulations to enable mitochondrial donation techniques
	to be used. As we have heard, expert scientific review panels in April 2011, March 2013 and June 2014 found no evidence to suggest that the techniques are unsafe for clinical use.
	If Parliament passes the regulations, specialist clinicians will have to obtain a licence from the HFEA to use the techniques. A licence will be granted only once the HFEA, operating case by case, is satisfied that any risk of using the techniques is low. I hope that the Minister will provide the House with more detail on the robust process that has been followed for us to reach this point. I ask her to set out the further safeguards built into the regulations to guarantee that the decision to use these techniques cannot be taken lightly.
	We have heard concerns that allowing mitochondrial donation is a dangerous road to start down, and might lead to designer babies and parents being able to select the physical characteristics of their children, which I would find absolutely abhorrent. However, we have also heard that those fears do not take into account that the regulations are very specific and cover only mitochondrial DNA, not the nuclear DNA that determines our physical characteristics, as was so eloquently outlined by the right hon. Member for Havant. We are talking about the use of these techniques only in the clearly defined situation of incurable mitochondrial disorders.
	The fact that the techniques apply only to the mitochondrial DNA and not to nuclear DNA should provide further reassurance to hon. Members who are concerned that the process will result in three-parent babies, as my right hon. Friend the Member for Holborn and St Pancras said. As we have heard, mitochondrial DNA controls only mitochondrial function and energy production; it is important to point out, as many hon. Members have done, that nuclear DNA, which makes us who we are and determines appearance and personality, is not altered by the proposed techniques. The Nuffield Council on Bioethics conducted an ethical review, which concluded that by “societal norms”, mitochondrial DNA
	“does not confer genetic identity.”
	Again, it would be helpful if the Minister put it on the record that children who are born from mitochondrial donation will have two biological parents and one mitochondria donor.
	Finally, I come to the issue of safety. There have been questions about the safety of the techniques. Again, we must be sure that we base our arguments on facts. Comparisons have been made with the cytoplasmic transfer techniques that were used by a private fertility clinic in the United States in 2002 and the current investigation into the health of the children born from that process. However, this is a fundamentally different technique, as the hon. Member for Mole Valley (Sir Paul Beresford) suggested.
	There are other safety concerns that apply directly to mitochondrial donation techniques, and those must be examined in detail. As we have heard, the technique has received unprecedented scrutiny by the HFEA’s specially convened expert scientific review panel. The question for us is whether the benefits of preventing the transmission of mitochondrial disease and the likelihood that children will continue to be born who will die in infancy outweigh the risks of the techniques. The scientific community and the families experiencing mitochondrial disease say that they do. It is now up to Parliament to decide whether it agrees.
	We are approaching the final stage in what has been a long and considered process, and we cannot delay it any further. Time is precious for the parents who are at risk of passing on mitochondrial inherited disease to their children. The research has been done, the reviews have been carried out, and the experts and the public have been consulted. The arguments have been made and the families are waiting. It is time for us to make a decision.

Jane Ellison: I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing this debate at the Backbench Business Committee and all the right hon. and hon. Members who have contributed. It has been an extremely thought-provoking debate. Inevitably, in the time available to me, which I believe is 10 minutes, I will not be able to do justice to every point, but I hope that Members know that if there is a point that I am unable to cover in my remarks, I will follow it up afterwards and attempt to respond to them.
	I welcome this opportunity to discuss mitochondrial donation and to reflect on the scientific and policy journey that has brought us to this point. As many Members have said, children are being born with and are dying from devastating conditions that are caused by mitochondrial disease. Scientists and clinicians have developed a treatment to tackle it but, rightly, Parliament will need to approve new regulations for it to be used.
	As Members have said, this is not a new subject for Parliament to be debating. In 2008, Parliament agreed amendments to the Human Fertilisation and Embryology Act in anticipation of these groundbreaking developments. That provided a power to introduce regulations that would allow mitochondrial donations. It is that next stage that is the focus of our deliberations.
	I will explain the thorough and open approach that has been used to assess the safety and efficacy of the proposed donation techniques, and to gauge the public’s views. This has not been a rushed process and I do not agree that Parliament is being asked to vote blind, as some have said—far from it, as others who have been in this House for longer than I have testified. We have asked the HFEA to convene a panel of experts three times since 2011 to review the scientific evidence on the safety and efficacy of the proposed donation techniques. All three reviews have indicated that the donation techniques—maternal spindle transfer and pronuclear transfer—would be effective, and all three reviews have found no evidence to indicate that either technique would be unsafe. To quote the chair of the expert panel, Professor Andy Greenfield, whom I have met to discuss the reports:
	“In three years’ study the expert panel has seen no evidence which suggests that these new mitochondrial replacement therapies are unsafe.”
	However, I appreciate that some Members have expressed concerns. Some are opposed in principle and some have practical concerns about whether we have looked at all the important details.
	The decision on whether a new treatment can be described as safe is never absolute, as Members have said. Doctors and scientists rarely, if ever, make an
	unqualified statement that a procedure is safe. Instead, they proceed by hypothesis, evidence and risk analysis. Indeed, no medical procedure is without risk, from a cataract removal to a triple heart bypass.
	There have been calls today for more research into mitochondrial donation, but research cannot be expected to answer every question. All that we can ask is that it adds to our knowledge and highlights areas that need to be looked into further and monitored more closely. We are currently considering the most recent report of the expert panel, the assurances that have been given on the safety and efficacy of the techniques involved and the recommendation of further experiments to confirm earlier findings.
	The draft regulations to allow mitochondrial donation, on which we consulted, would also bring into place important safeguards, as others have said, through the HFEA’s strict licensing procedures. For a licence to be issued to a provider of mitochondrial donation, they would first have to demonstrate that they could carry out the procedure safely and effectively.

Edward Leigh: Will my hon. Friend give way?

Jane Ellison: I will take only one intervention, if the House will allow me.

Edward Leigh: It has been said in the debate that we are not creating three or four-parent families, but given that the cells of a second mother will be used, will a child have a legal right to know the identity of the three or four people who contributed to their creation?

Jane Ellison: That was one area of detail covered in the draft regulations and the responses to the consultation on it, and I will write to my hon. Friend with a detailed response. A wider point is that we should surely not reduce the notion of parenthood to genes. Many Members who have spoken in the debate, particularly my hon. Friend the Member for Congleton, who moved the motion, have often spoken in other contexts about parenthood being more about loving, nurturing and so on. It cannot be reduced simply to the donation of genes—I worry that that, in itself, would be a slippery slope.
	Mitochondrial donation is supported by both the chief medical officer, Professor Dame Sally Davies, and many clinicians and IVF experts, including, I am pleased to say, Professor Lord Winston, who has been quoted a number of times in the debate. Among other comments, he has made it clear that he supports the draft regulations and would vote for them.
	This is undoubtedly a really difficult area in which to gauge public opinion, because it is complex and technical and a lot of people know nothing about it. Some Members who have seen e-mails going around the House asking them to attend this debate have told me that they did not know what it was about. That means that the exercise of engaging the public needs to be carried out in a thoughtful and comprehensive way. That was exactly what the Government did—we tested the public acceptability of introducing these techniques through a comprehensive dialogue process commissioned by the HFEA and led by external experts. It included events such as workshops and focus groups, and it showed that when the process of mitochondrial donation was fully
	explained to them, the majority of people supported its use provided that it was carefully regulated. The Department of Health’s consultation was on the draft regulations, and those who commented on them broadly supported them. I urge people to be mindful of the way to go about testing public opinion on the matter. We have to ensure that it is done on the basis of facts.

Lady Hermon: rose—

Jane Ellison: I am really sorry, I just do not have the time to give way. I am not being discourteous.
	Successive Governments have responded to advances in science that were controversial in their day. Time does not permit me to go into them in as much detail as I would have liked, but many Members will cast their mind back to the debates about IVF. I suspect that there are Members in the Chamber today who were extremely wary of IVF techniques but who have written to me in the past year asking me to help infertile couples in their constituency. We were told in the debates on IVF that the proposal for limited research on embryos, up to a maximum of 14 days’ development, was a slippery slope and that the 14-day rule would become 20 days, 50 days or even six months. Today, 25 years on, the Rubicon remains uncrossed and the important provision that research cannot take place on embryos more than 14 days old, which Parliament put in place, remains firmly in place. I hope that that gives Members some reassurance.
	Mitochondrial donation will enable people to have their own, genetically related children, free of serious mitochondrial disease. The proposed donation techniques will allow unaltered nuclear DNA to be transferred only to an egg or embryo that has unaltered healthy mitochondria. I could not have put it more eloquently than my right hon. Friend the Member for Havant (Mr Willetts) did when he talked about the difference between nuclear and mitochondrial DNA.
	On the issue of three parents, I mentioned—as have others—that we cannot reduce parenthood to a matter of 37 genes from a donor. It is about so much more than that, and our draft regulations refer to some of the safeguards in place.
	There is no cure for mitochondrial disease, nor is there one on the horizon. The families of children born with severe mitochondrial disease face the prospect of having to watch their child suffer dreadfully, and in many cases die at an early age. Many Members have met constituents in recent months—as have I—who are facing that heartbreaking situation, and I pay tribute to the Lily Foundation for its work in helping us all to connect with those constituents.
	This has been a thoughtful debate, and it is vital that Parliament discusses such matters openly and considers all the issues. For those who are not opposed in principle, we must consider all the evidence alongside the benefits that this treatment can bring, and make that consideration in a rational way. The Government will, of course, continue to consider the expert advice we have received
	and how that influences regulations before they are brought before Parliament for further debate. We believe that this is an important scientific advance that holds out great hope for families in this country and around the world.

Fiona Bruce: I thank all hon. Members who have contributed to this debate. The number who have contributed and the serious intent and concerns expressed highlight the grave concern that Members feel about this issue, which I believe reflects public concern. That is why it is so important that the final decision on this issue is brought back to the House. Full debate and consideration should be available to us after the critical research recommended by the Human Fertilisation and Embryology Authority has been conducted, published and peer reviewed.
	My hon. Friend the Member for South Derbyshire (Heather Wheeler) said that we should listen to the science, and that is precisely my point. It is said that the Government intend to lay regulations this autumn, before the pre-clinical research recommended by the HFEA in its three reports has been concluded, written up and assessed in peer reviewed journals. I simply say that it cannot be right to ask the House to make such a decision before the tests have been concluded. As my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) said, there has always been an understanding that we must proceed only when the safety of these issues has been properly assessed.
	As a mother, I know that no mother would want to conceive a child with mitochondrial disease, but neither would they want to conceive a child with potential genetic abnormalities because adequate safety tests on maternal spindle transfer and pro-nuclear transfer were not carried out.
	Question put and agreed to.
	Resolved,
	That this House takes note of the Human Fertilisation and Embryology Authority’s most recent scientific review into the safety and efficacy of mitochondrial replacement techniques which highlights concerns for subsequent generations of children born through maternal spindle transfer and pronuclear transfer; welcomes the recent comments of scientists including Professor Lord Winston that, prior to the introduction of such techniques, more research ought to be undertaken and a full assessment conducted of the potential risk to children born as a result; and calls upon the Government, in light of these public safety concerns, to delay bringing forward regulations on mitochondrial replacement.

Sarah Wollaston: On a point of order, Madam Deputy Speaker. Is it in order to ask whether Professor Lord Winston was consulted before his name was added to the motion on the Order Paper?

Eleanor Laing: It is in order to ask the question. I cannot give the hon. Lady an answer, but I have heard what she said, and I am sure that those who were involved in that have heard what she said. If the noble Gentleman was not consulted, I would consider that to be most discourteous.

Hazaras (Afghanistan and Pakistan)

John Denham: I beg to move,
	That this House has considered the position of Hazaras in Afghanistan and Pakistan.
	I am grateful for this debate, and I speak as an MP and as chair of the Hazara all-party parliamentary group. In recent weeks, we have seen ethnic and religious minorities face appalling violence at the hands of the Islamic State of Iraq and the Levant in Iraq and Syria. This debate is about another community that has suffered at the hands of very similar ideologues for far too long.
	I knew little of the Hazara until I met constituents who were part of the Hazara diaspora and who had been forced to flee violence. I believe that might be true of other right hon. and hon. Members who want to speak in this debate. The Hazara are an indigenous people of Afghanistan, predominantly but not exclusively Shi’a Muslims. The community in Quetta in Pakistan’s Balochistan province was established in the late 19th century by Hazaras fleeing religious persecution in Afghanistan. It largely prospered, providing education for men and women and showing a deep-seated and industrious work ethic, until it became the target of terrorist attacks from about 1999.
	Hazaras comprise between 10% and 20% of the population of Afghanistan. Persecution continued into the Taliban era, with thousands killed in massacres during the civil war and under the Taliban Government. In part, the Hazara are victims of the violence against Shi’a Muslims and other religious minorities that is endemic in Pakistan and has featured strongly in the history of Afghanistan. I do not want to underplay the common features shared with the wider violence against the Shi’a community, but Hazaras have suffered disproportionately, in part because their distinct ethnic identity makes them easily identifiable and targets for prejudice and discrimination.
	There is little doubt that sectarian groups have received finance from states and individuals in the Gulf. Today, they might be recognising just what they have created in Iraq and Syria, but we and other western countries have been silent for far too long on their role. Just occasionally, the violence in Quetta makes the international news: in June 2012, when a university bus was bombed, killing four and injuring 72; and in early 2013, when two bombings killed 180 Hazaras. Continuing violence has been well documented in the recent Human Rights Watch report “We are the Walking Dead”, published in June 2014.
	The community in Quetta comprises about 500,000 people, yet nearly 1,500 people have been killed since 1999 and more than 3,500 injured. The attacks have targeted breadwinners and forced businesses to close, promoting economic deprivation, while some recent attacks have directly targeted women and children. Perhaps 55,000 people have fled to Australia or Europe—of course, not all survived the journey—and following attacks on transports, students no longer attend university. In Quetta, the community is restricted to two enclaves with a total area of just 4 square miles. The community is isolated, with travel restrictions imposed by the Pakistani Government.
	Shockingly, in the past 16 years, not one person has been brought successfully to justice. The al-Qaeda-affiliated organisation Lashkar-e-Jhangvi has openly claimed responsibility for the killings, while leading members have been seen associating with public figures and politicians in Pakistan. A few people have been arrested, but have then been released or able to escape or cases have been dismissed. It is clear that the Pakistan authorities have failed to act with any effectiveness to protect the Hazara community, with attacks taking place close to the presence of security forces.

Andrew Smith: I congratulate my right hon. Friend and the others who have secured this debate, and I agree with everything in his very powerful speech. Does he agree that given the inability or unwillingness to bring people to justice for these horrors in Pakistan and Afghanistan, and given the hideous murders that have taken place, it is high time that the United Nations referred Lashkar-e-Jhangvi and other groups alleged to be responsible to the International Criminal Court in order to send the most powerful signal possible that this is utterly unacceptable to the international community?

John Denham: I think there is indeed a strong case for that, and I will come in a moment to the responsibility of the international community.
	In other parts of Pakistan, the Pakistan state has made significant efforts against, for example, the Pakistan Taliban, that have not been made in Quetta. The Pakistan Government are clearly in breach of their international obligation to protect their people. We should call tonight for effective action by the Pakistan state, but those demands must be consistently reinforced by the international community, by individual Governments, including our own, and by international institutions, including the United Nations and its agencies, and that must be done in every relationship—political, military, development and human rights.
	Demands for change must be central to our relationship with Pakistan, not just raised occasionally or at a junior level. Last year, the then Foreign Office Minister Baroness Warsi did raise those issues with Prime Minister Sharif and he denounced sectarian killings. What we now need to see is visible action to investigate those killings and prosecute those, particularly the LEJ leadership, who have claimed responsibility. Militant groups should be disbanded and those such as the political wing of the LEJ, which in March this year celebrated killings and pledged to eliminate Hazaras from Balochistan, must be brought under control.
	We need the Foreign and Commonwealth Office and the Department for International Development to recognise the roots of the problems faced by the Hazaras. I would like to see DFID develop assistance programmes to address the immediate needs of the community in Quetta. I would also like to see the conflict pool—the UK fund for conflict prevention, which already operates in other parts of Pakistan—extended to Balochistan. Big efforts must be made to engage the UN system, as my right hon. Friend the Member for Oxford East (Mr Smith) said. The UN system has strong policies on human rights, preventing genocide and the protection of indigenous peoples, all of which should apply to the Hazara. While some recent and welcome progress has been made, much more could be done.

David Burrowes: Will the right hon. Gentleman give way?

John Denham: I will take one more intervention.

David Burrowes: I thank the right hon. Gentleman and congratulate him on securing this debate. In 2012 there was an international conference on the genocide of Hazaras—indeed, the new Minister, whom I welcome to his post, was present. I notice that at that time not a single perpetrator had been arrested or brought to justice. Has there been any change in that regard?

John Denham: There have been some arrests, as I understand it, but nobody has yet been successfully brought to justice. That is a matter of grave concern.
	As I said, the UN has strong policies, but we have to make much more progress at the international level. Let me turn briefly to Afghanistan. The fall of the Taliban brought representation in the political system and support for the Hazaras’ long-standing commitment to educate girls as well as boys, though widespread discrimination continued. There have, of course, been atrocities, notably the killing of more than 60 people, mostly Hazaras, in Ashura in December 2011. However, fears are now rising of what might happen after the withdrawal of international troops. Secure and stable government is by no means assured, and the current political stalemate following the elections is hardly encouraging.
	The security situation is becoming increasingly volatile, and Taliban forces are increasing their control of territory. We have seen the killing and forced displacement of Hazaras from Khas Uruzgan and killings and disappearances along the roads from Kabul to Bamiyan, Ghazni and Heart, with 30 Hazaras killed in three separate attacks on those highways in July 2014 alone. It is understandable that Hazaras fear a return to the scale of abuses they experienced under the Taliban regime. It is hardly encouraging that two of the Taliban released by the US in a recent prisoner exchange were Mullah Fazl and Mullah Norullah Noori, who both participated in the massacre of thousands of Hazaras in the late 1990s and early 2000s. That does not show a sensitivity to the history or the future dangers.
	The message that we want to convey from tonight’s debate—happening as it is just a few days before the NATO summit—is that even as troops are withdrawn, the international community cannot afford to lose interest in what happens in Afghanistan. The international community needs a clear agenda for its continuing aid and political relationship with the Afghan Government, which should include pressure to address the continuing discrimination and under-representation of Hazaras within the Afghan Government and state, and to assist the Afghan Government in ensuring the protection of ethnic and religious minorities following troop withdrawal.

Stella Creasy: Will my right hon. Friend give way?

John Denham: I will give way one last time.

Stella Creasy: I thank my right hon. Friend for giving way. I wonder whether he believes it would also be helpful to have direct Hazara representation in discussions at the NATO summit as a result of the points he is making so eloquently.

John Denham: It is a real issue that the Hazaras have often not been given a voice in international conferences and also, I have to say, in relation to our Government and their aid programme. That voice must be found.
	My final point is this. The international community now generally recognises that talks between the Afghan Government and the Taliban are both unavoidable and necessary, but it has to be made clear that such talks cannot be allowed to exclude the protection of minority rights as part of any long-term solution. Even after the withdrawal of international troops, I still think we should be in a position to ensure that those issues remain on the agenda.

Several hon. Members: rose—

Eleanor Laing: Order. Unfortunately, because there has been a surge in demand to speak in this debate, I shall have to maintain the three-minute limit of the previous debate. I call Jeremy Lefroy.

Jeremy Lefroy: Thank you, Madam Deputy Speaker, and I congratulate the right hon. Member for Southampton, Itchen (Mr Denham) and indeed the Backbench Business Committee on bringing this debate forward. You will be glad to hear, Madam Deputy Speaker, that because the right hon. Gentleman has eloquently outlined the situation that the Hazaras face, I intend to make just one point.
	I wish to say that it is the responsibility of every Government on this planet to look after their minorities—whatever they think of them, whatever the background or history. Governments have the responsibility to protect their minorities. We are not necessarily here to dictate political systems or say whether minorities such as the Hazaras should have this or that kind of democracy, but it is a fundamental role of any state to protect and to provide safety and security for all its people, and not to discriminate against any one people because of their faith, creed, colour or whatever else.
	That leads precisely on to the point made by the right hon. Member for Southampton, Itchen: it is up to the UK Government, in whatever way they interact with another Government, in Pakistan, Afghanistan or elsewhere around the world, to oppose any discrimination against and persecution of minorities simply because of who they are, and wherever that discrimination and persecution are taking place. It is for the UK Government at each and every opportunity, whether it be through development, military, diplomatic or even economic relations, to make that point. As I say, this does not apply only to Pakistan and Afghanistan, as we could think of dozens of other places where it is happening. It is a duty to protect minority citizens and give them equal rights with others.
	In my work on the International Development Committee, I sometimes feel that we do not take up this challenge enough. Let us not forget that Pakistan is the single biggest bilateral recipient of UK aid. We have clout there. When our Committee visited Pakistan a couple of years ago, we could not go anywhere near Quetta or to Balochistan because of the situation there. We could go to Khyber Pakhtunkhwa and Punjab and we saw some excellent work being done there, but we
	could not go to a place where all these things were going on at the time. I believe that it is for our Ministers in the Department for International Development and for parliamentarians on the International Development Committee to raise those matters whenever we have the opportunity. We may be ignored and there may be no action, but we could be listened to and it is our responsibility to act as I have suggested.

Alan Whitehead: As my right hon. Friend the Member for Southampton, Itchen (Mr Denham) eloquently put it in his introduction to the debate, this Hazara community does not have a nation; it has parts of a nation and has had a substantial diaspora across the world, with perhaps a million Hazaras in Iran, more than half a million in Pakistan and between 1 million and 2 million in Afghanistan. These people have suffered historically from enormous persecution, which in many ways continues today.
	If I have time, I would like briefly to read out a letter that was circulated in Quetta at the time of the arrest of a leader of the Lashkar-e-Jhangvi, a body that continues openly to pursue attacks against Hazaras in Quetta and around. The letter says:
	“All Shi’ites are worthy of killing. We will rid Pakistan of unclean people. Pakistan means land of the pure and the Shi’ites have no right to live in this country. We have the edict and signatures of revered scholars, declaring Shi’ites infidels. Just as our fighters have waged a successful jihad against the Shi’ite Hazaras in Afghanistan, our mission in Pakistan is the abolition of this impure sect and its followers from every city, every village, and every nook and corner of Pakistan.
	As in the past, our successful jihad against the Hazaras in Pakistan and, in particular, in Quetta, is ongoing and will continue in the future. We will make Pakistan the graveyard of the Shi’ite Hazaras and their houses will be destroyed by bombs and suicide bombers. We will only rest when we are able to fly the flag of true Islam on this land of the pure. Jihad against the Shi’ite Hazaras has now become our duty.”
	That organisation is dedicated to eradicating an entire ethnic group from the face of the earth. Those are the circumstances under which the Pakistani Hazaras live daily, with the results that my right hon. Friend the Member for Southampton, Itchen described.
	There have been atrocities—for example, when a number of people were blown up on a bus while on a pilgrimage. When asked how he intended to “stem the tears” of the Hazara community, the then Chief Minister of Balochistan said:
	“Of the millions who live in Balochistan, 40 dead in Mastung is not a big deal. I will send a truckload of tissue papers to the bereaved families.”
	That is the reality of life for Hazaras in Pakistan and in other places. It is incumbent on us to raise the issue internationally and to call on the Pakistan Government and international agencies to ensure that the rights that any of us would expect are protected, including the rights of this vibrant community, part of which I am delighted to say is resident in my constituency.

Mike Thornton: I pay tribute to the right hon. Member for Southampton, Itchen (Mr Denham) for his sterling work on the issue. The subject was
	brought to my attention by Luci Woodland, who is part of the APPG and who told me that no one knows this is happening. We have heard about what is going on. We have heard the numbers. Amnesty International says that the targeting of Hazaras is increasing. That must frighten all of us. It is incumbent on all Members to spread the word. That is what we need to do. We need to ensure that people know what is going on. The press do not report it. The BBC does not report it. Sky News does not report it. We must persuade people to let everyone know what is happening.
	Many years ago, people of my generation used to write postcards to Amnesty International about prisoners of conscience because we knew that, once the dictators knew that we knew what was going on, they would start to change their behaviour. It is the same when it comes to the Hazaras. Governments have been pursuing those kind, decent, gentle people, who educate all their children, male and female, and are renowned for their music and poetry, not violence and intolerance. The only way we can get Governments to listen and people to pay attention is if people know what is going on. If enough people start making a noise, things will change. Therefore, I ask everyone in the Chamber and anyone out there who happens to be listening to the debate to make the situation known, to listen and to write to the newspapers to ensure that people hear what is going on in Pakistan and Afghanistan.

Martin Horwood: My hon. Friend is speaking eloquently. He is calling for a public outcry. Will he also press the Government to ensure that the £0.5 million or so that we are spending on the Afghanistan Independent Human Rights Commission is reflected in the concern for the Hazara community, too?

Mike Thornton: I thank my hon. Friend for that intervention. It is vital that we do that. It is important that we use the money, the influence and the power we have to ensure that things start to change. I have been horrified by what I have found out. I was almost moved to tears in talking to Hazaras who have been exiled from their homeland by intolerance and violence. I knew nothing about it before I turned up at the first APPG, which the right hon. Member for Southampton, Itchen chaired. We have heard the figures. There is no point in me repeating what I have written down and what everyone else has said. I ask Members to pay attention and to think what it would be like to live in a situation where one is persecuted not just because of one’s religion but because one looks different from one’s neighbours. Hazaras look different from other Pakistanis and Afghans because they have a Mongolian ancestry, so they are being persecuted for racial as well as religious reasons. It is shocking and horrifying, and we must spread the word to make sure that things change. I ask all Members to do everything they can to ask for that change.

Madeleine Moon: As we have heard, the Hazaras are Persian-speaking people who live mainly in central Afghanistan. They are overwhelmingly Shi’a Muslims and make up the third largest ethnic group in Afghanistan, forming about 9% of the population. Their distinctive facial features in comparison with the Pashtuns, who make up 42% of the Afghan population,
	makes them easy to identify, marginalise and persecute. During the Taliban rule, the Hazaras suffered a repeated and systematic campaign of violence. Wholesale persecution of the people dates back to fatwas issued against them in the 1890s. Despite the genocidal campaigns, the Hazaras are still the third largest ethnic group in the country. Approximately 4.8 million live in Afghanistan, 1 million in Iran, and 550,000 in Pakistan. Despite their numbers, however, the Karzai Government had no Hazara Ministers, only 5% of Government officials are Hazara, and none of the 10 candidates in April’s presidential election was Hazara.
	One of the main achievements in Afghanistan has been to bring a measure of democracy and representative government to the people of that country, but many obstacles still exist. All of us know all too well that there is more to democracy than voting and more to democratic government than representing the views of the majority. A true democracy is one where not only are the views and wishes of the majority represented but the needs of the minority are given protection and respect.

Jim Shannon: There seems to be an attitude permeating through the Pakistani Government that picks on small ethnic groups and religious groups, and does so purposely because they are small. Does the hon. Lady think that we should take the action suggested by other Members and try to redirect DFID money to those who need it most rather than to the Government who are taking it out on people in minorities?

Madeleine Moon: The hon. Gentleman, as always, is trying to steal my best lines. I ask him to wait until my conclusion.
	If Afghanistan is going to survive, the rights of groups such as the Hazara need not only to be tolerated but fully accepted and incorporated into the workings of the state. This is no small task or easy feat even in the best of circumstances, but many of the ingredients are there. Article 2 of the constitution guarantees freedom of worship and article 22 clearly states the equal rights of all Afghan citizens before the law. The most difficult tasks that Afghanistan has to meet are freedom of worship and equal rights. At the end of the day, this will be the only way of ensuring the well-being of minorities and the stability of the whole country.
	The British Government have committed to provide ongoing financial support for Afghanistan and Pakistan. This House must make it very clear today that we will be watching to see how all minority groups are protected and engaged with, and that when considering our financial support we will be looking for freedom of worship and equal rights for all minorities.

John McDonnell: Like everybody else in the Commons today, I knew nothing about Hazaras until a small group of my constituents turned up in my constituency office and took me through their experience, which was horrendous. The group travelled as pilgrims and on the coach they were divided on ethnic lines, taken off, and a number of them murdered on the spot. That was just one experience. When I witnessed the photographs and the reports, I felt, like everyone else, lacking because I did not know about this and a sense of a sin of omission in not doing anything about it.
	The other thing that came up in the discussions with the group was their anxiety that the perpetrators of this violence against them, particularly in Pakistan, were operating with virtual impunity, with no action taken against them or only tokenistic arrests. Then there was the bizarre element that some of those who had been arrested were allowed to escape, with clear collusion on the part of the authorities.
	I told my constituents that I would do everything I possibly could to support the all-party group—I congratulate my right hon. Friend the Member for Southampton, Itchen (Mr Denham) on establishing it—and also to look at how we systematically approach this so that we have a method of working in which, as my hon. Friend the Member for Bridgend (Mrs Moon) said, we bring attention to the issue and do not allow it ever to be dropped again.
	I want to thank Baroness Warsi for the work she did and the commitment she undertook on this issue, but may I make a suggestion to the Minister? I know he has offered to meet the all-party group, but a systematic report from Government on how we are going to approach this issue on a whole range of levels would be helpful.
	Obviously, there is an element of carrot and stick. In terms of positive assistance through DFID, there is a question as to how we target resources with regard to the Hazara community in Pakistan and Afghanistan, and what support we can concretely give them, because they are suffering economically as a result of the oppression they are facing. The second point is to do with the conflict pool and conflict prevention and resolution. We have looked at proposals in other areas where we support Human Rights Watch and other human rights organisations to put people on the ground, including supporting the Hazaras in terms of the legal representation they need on individual cases.
	Thirdly, there is an element of stick. As has been said, Pakistan receives a significant amount of aid from this country. It is also a significant trading partner with us. All of those trading agreements now have a commitment to human rights embodied in them, but that is not being fulfilled. We must explain to the Pakistani Government in particular that if they want this relationship with us, they have to start delivering by addressing human rights abuses in this particular instance, and we should invite them to bring forward their programme of work for tackling this disgraceful abuse of the Hazaras.
	I want the Minister to meet the all-party group, but also to prepare a systematic report on how we can bring forward this issue so that we can protect this community.

Mike Gapes: In recent weeks we have been commemorating events relating to the first world war. One thing we have been commemorating is the contribution of the British Indian army and those people who came out of the colonial past of 100 years ago and gave their lives for our country. Many of them were Hazaras.
	Hazara groups were part of the British Indian army from the early years of the last century. They were involved in many parts of the world, including the middle east, as part of a group of Hazara Pioneers who came out of Quetta.
	At that time, the colonial civil service was also staffed by many Hazaras. Their commitment to education and the role of women in society has been mentioned, and that is an important reason why they were used by the British colonial authorities. As a result of that, however, there is discrimination against and hostility to this minority from some other groups. The Hazaras face not just the problem that they are Shi’a predominantly, but also the problem that their commitment to girls’ education draws hostility from adherents to the more virulent forms of misogyny and hatred of education of girls that comes out of the Taliban, as we have seen in recent years.
	The Hazaras come from Bamyan province in Afghanistan, which is where the Taliban destroyed the ancient Buddhas of another religious minority that were part of the history of that country. As my hon. Friend the Member for Bridgend (Mrs Moon) said, we need to be very vigilant about what happens in Afghanistan over the next two or three years. Whoever eventually becomes President—if anybody ever does and they ever do finish the process of election verification and counting—must be held to account.
	We will need to make sure that the Afghan Government speak for, and represent, all of the communities in Afghanistan, and we must also use our diplomatic channels and our aid programme in a targeted way to assist minorities within Pakistan. Britain has a great relationship with Pakistan and that must continue, but we also need to speak up for minorities there.

John Spellar: First, I congratulate my right hon. Friend the Member for Southampton, Itchen (Mr Denham) on securing this short but significant debate. He has had a long history of campaigning for the Hazara community during his time in Parliament, and they will greatly miss his voice when he retires at the next general election, as indeed will his wider constituency in Southampton.
	As hon. Members will be very much aware, the persecution of the Hazaras is part of a greater tide of religious and ethnic intolerance and persecution around the world, and of appalling brutalities perpetrated on those of a different faith or community. The barbarities of ISIS are the most recent, graphic and disgusting examples, but, unfortunately, they are by no means unique. Equally reprehensible is the acquiescence, even complicity, of state bodies in actions against minority groups, particularly faith groups, and hon. Members have given examples of that. My right hon. Friend and his parliamentary neighbour, my hon. Friend the Member for Southampton, Test (Dr Whitehead), drew attention to some of those, particularly the failure to take action against Lashkar-e-Jhangvi. That organisation has proudly claimed responsibility for some of the attacks, yet many of its leaders continue to play command and leadership roles, they avoid prosecution, they escape and they evade accountability. Some of them, having been arrested, have even escaped from military and civil detention in circumstances the authorities have found hard to explain.

Bob Stewart: The International Criminal Court is the court of next resort which may well prosecute such people, and we should make much greater use of it when states refuse to prosecute individuals.

John Spellar: I thank the hon. Gentleman for his intervention. I am sure it has been noted by the Foreign Office Minister. Part of the effectiveness of this debate is in raising this in the order of priorities of not only the Foreign Office, but the Department for International Development, which has been mentioned by a number of hon. Members.
	The only redeeming feature at the moment of this situation is the much greater level of public awareness and debate on these issues, and the welcome attention in the political world. Today’s debate is one example of that. In this House there has been a growing interest in the persecution of not only the Hazaras, but of Rohingya Muslims in Burma, of Baha’is in Iran and of the Ahmadiyya community in a number of Muslim countries. Increasingly, we have also seen persecution of various Christian groups in a variety of countries across the world, particularly in the middle east and Indian subcontinent, including Pakistan, to which I will return in a moment. For many people, campaigning on their behalf often seems a lonely road to be travelling, as they try to get a message across about the horrors to a world that is unaware, as many colleagues have rightly indicated. Therefore, this level of interest from Parliament and Government is particularly welcome. As we are seeing tonight and in other debates, these issues unite those on both sides of the House—Government and Opposition alike.
	In early July, the shadow Foreign Secretary, my right hon. Friend the Member for Paisley and Renfrewshire South (Mr Alexander), rightly said in a speech to Christians on the Left that
	“The first centuries of Christianity are often described as being scarred by blood, violence and brutality. And yet the plight of Christians today could go down in history as one of the most brutal periods of our common history.”
	That is being borne out on a daily basis on our television screens. He also rightly stressed that
	“wherever Christians are persecuted, the right to religious freedom for all is jeopardized.”
	There have been particular concerns about the failure of the state—and even its involvement and that of its institutions—to protect those who practise Christianity in Pakistan. As my hon. Friend the Member for Bridgend (Mrs Moon) rightly said, we will be watching carefully for any failure of the state to protect minorities, including the Hazara. We will be watching for any failure of the state in Pakistan, and indeed in Afghanistan, in its duty to provide that protection: where it is failing to protect them from other groups, leaving aside what it is doing in its own right. We also need to be clear that the right to freedom of religion includes the right to change one’s religion, as well as the right not to believe. Those rights are enshrined in the Universal Declaration of Human Rights, which was agreed in 1948 after the horrors of world war two. In ringing tones, it declared:
	“Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.”
	The international community should be working, striving and insisting on those rights.
	It is good to see this issue being dealt with in the broader context, but we must also focus on the particular, so that the voices of the persecuted are heard. That is
	why today’s debate is so welcome. As my right hon. Friend the Member for Southampton, Itchen (Mr Denham) said, the position of Hazaras in both Afghanistan and Pakistan is especially hazardous, particularly with the uncertainties that we are anticipating with the end of the NATO military drawdown. There are also continuing uncertainties over the outcome of the presidential election and whether there will be an inclusive Government in Afghanistan. That inclusivity needs to draw in not just all the major actors but all the communities in the country. As I have repeatedly said, it is also vital that there is early involvement by the neighbouring countries, all of which have an interest in stability in Afghanistan, but all of which could lose out if they try to play for sectional advantage, which will contribute to breakdown. Minorities such as the Hazara, which is probably one of the worst treated groups in the region, need to have their rights protected.
	It is clear that many extremist groups are still receiving protection from the authorities. Although a ban has been in place since 2002, it has not stopped them from carrying out attacks across Pakistan. Civilian and military security forces deployed in Balochistan have done little to investigate the attacks on the Hazara or to take steps to prevent the next attacks. The head of LEJ has been prosecuted for alleged involvement, but has not been convicted. Now we are seeing some of those who have been involved in the atrocities against the Hazara being released from prison.
	Tonight, all parts of the House are calling not only for greater public awareness but for the Foreign Office and Department for International Development and international forums to make the persecution of Hazaras a priority in their discussions with the Governments of Pakistan and Afghanistan. Such a call is not only in our interests but a matter of decency.

Tobias Ellwood: I am grateful to the right hon. Member for Southampton, Itchen (Mr Denham) for calling for this debate and for ensuring that it took place on such a busy day in the Chamber. Important contributions have been made by Members from all parts of the House. I will try to touch on some of them, but if I do not get through them all, I will write to hon. Members.
	My hon. Friend the Member for Stafford (Jeremy Lefroy) mentioned the important role of the International Development Committee and the work of DFID. I hope that they will continue their studies in this area. Britain is committed to providing £70 million for a number of years in Afghanistan, and we are one of the major donors in Pakistan as well.
	The hon. Member for Southampton, Test (Dr Whitehead) spoke about the role of Iran and the responsibility of the Pakistani Government to do more and not turn a blind eye to the various incidents taking place.
	My hon. Friend the Member for Eastleigh (Mike Thornton) spoke about improving knowledge of what is happening with the Hazaras not just in this place but in Britain as a whole. The hon. Member for Bridgend (Mrs Moon) said how easy it is to identify the Hazaras because of their make up and also spoke about the role of the Afghan Government in addressing some of the
	issues. It is good to see that the second assistant President is a Hazara and that one fifth of MPs in the Afghan Parliament are Hazaras, too. Unfortunately, the same cannot be said in Pakistan.
	The hon. Member for Hayes and Harlington (John McDonnell) spoke about a report on tackling these issues. This is now the third such debate in as many years and I hope that it will become an annual event. The FCO’s annual human right report and quarterly updates comprehensively cover persecutions faced by all, including the Hazaras, so perhaps we should have a debate on the report itself to highlight that point.
	The hon. Member for Ilford South (Mike Gapes) spoke about the future of the Afghan Government. He is perhaps better aware than most that we are in a bit of a stagnation period at the moment and are waiting for an outcome and for votes to be counted. Once that happens and there is agreement about what Britain’s and the international community’s role can be, we can step forward and start addressing some of the other issues.
	The right hon. Member for Warley (Mr Spellar) spoke about LEJ, the prime persecutor of the Hazaras. We should bear it in mind that it is not the only one, but it is obviously the focus of our attention.
	The conflict pool was mentioned by a number of right hon. and hon. Members and has now been replaced by the conflict, security and stability fund, which is a much longer phrase for us to get our heads around. There certainly needs to be more focus on what we can do using that fund. The forthcoming NATO summit was mentioned and I will certainly do my best to have a number of bilaterals on this subject. I had the fortune of speaking to our high commissioner in Pakistan on the matter this evening.
	This is an area with which I am familiar. I congratulate the right hon. Member for Southampton, Itchen, who is a bonus to this House, on showing how a constituency matter can be moved forward. He has become very much an expert in the matter and I think the whole House is grateful to him. I was the former co-chair of the all-party group on Afghanistan and I visited the country and the region a number of times, so I am pleased to be able to take on the portfolio and move the agenda forward.
	As I have said, this is the third debate since 2012 on the position of the Hazaras and it remains an issue of grave concern for Her Majesty’s Government. Sadly, the difficulties faced by the Hazara community, which the right hon. Member for Southampton, Itchen raised in this House last year, remain in 2014 and it is a tragedy that people from minority communities across Pakistan and Afghanistan, including the Hazaras, suffer the scourge of sectarian violence, a scourge that should not have a place anywhere in the world in the 21st century.
	The appalling acts of sectarian violence are well-documented by human rights groups and the FCO’s own quarterly human rights report on Pakistan, which I have mentioned, highlighted that the first three months of 2014 saw no substantial improvements. Our human rights report on Afghanistan continues to view the situation as poor.
	In Pakistan and Afghanistan, sectarian violence is not isolated to the Hazara community. We must remember that the former senior Minister of State at the Foreign
	Office, the right hon. Baroness Warsi, who has already been mentioned in the debate, highlighted on many occasions how ethnicity, religion, the freedom to have a religion and the right to believe what one chooses to believe extend across sectarian lines. Both Pakistan and Afghanistan have laws and constitutional protections for the rights of citizens and minorities, but turning those words and genuine commitment from the Governments into action is where much of the challenge lies. We recognise that Afghanistan and Pakistan face significant internal security challenges that have seen thousands of their citizens of all faiths killed in terrorist and other violence, which is why Her Majesty’s Government are committed to ensuring that both countries understand the need for urgent resolution to the violence faced by the Hazaras as well as by other minority groups facing persecution.
	We do not underestimate the difficulty of that challenge, but we will not shy away from urging real commitment to progress. We remain unequivocal in our call for the Governments of Pakistan and Afghanistan to address the concerns of all their citizens, regardless of ethnicity, religion or gender, and we continue to raise the issue at both ministerial and senior ministerial level, including Baroness Warsi’s visit to Pakistan last year following her meeting with representatives of the all-party parliamentary group on the Hazara. We will monitor and shine a spotlight on the plight of the Hazara and other minorities in Afghanistan and Pakistan, including through the Foreign and Commonwealth Office human rights report.
	Our relationship with Afghanistan and Pakistan on aid remains significant. Of course, we do not make our aid conditional on specific issues, which will remain the case, but UK aid to any country is based on three shared commitments with partner Governments: first, poverty reduction and meeting the millennium development goals; secondly, respecting human rights and other international obligations; and thirdly, strengthening financial management and accountability. In Pakistan, our aid helps the authorities to make progress in those areas, including concrete measures to improve the economy, reform education and devote proper attention to human rights.

John Spellar: But many of those objectives are undermined by the uncertainty and the terrorism being inflicted on the Hazara and other communities, particularly those who are among the most commercially productive and entrepreneurial. Is there not therefore a direct link between the objectives and getting change in behaviour?

Tobias Ellwood: The right hon. Gentleman is right to highlight that. That is why we are focusing on those three areas of education, tackling poverty and confronting the extremist narrative.
	I am conscious of the time and wish to allow the right hon. Member for Southampton, Itchen the opportunity to give us his final thoughts on the subject, so I conclude my remarks by reiterating that the UK is committed to the enduring relationship with Pakistan and Afghanistan and all their peoples, regardless of faith or ethnicity. We will continue to work with the leaders of Pakistan and Afghanistan to address ethnic and religious persecution. We will remain unwavering in our commitment to frank discussion with them as our friends. We will not shy away from tough messages on the rights of minorities.
	Having recently taken the responsibility for Afghanistan and Pakistan within the Foreign Office, I am committed to ensuring that those issues receive the attention they deserve. I look forward to meeting members of the all-party parliamentary group in due course to ensure that I understand the issues fully. Once again, I thank the right hon. Gentleman and others for ensuring that this important issue receives the attention it deserves.

John Denham: I thank the Minister. I know that his interest in these matters predates his appointment to the Front Bench, on which I congratulate him. I hope that we can develop the same relationship we had with his predecessor, who personally went further than other Ministers had done to raise the issue with the Pakistan authorities.
	I want to say three things. First, I want to put on record my tribute to the Hazara community in this country. A group of people, most of whom came here as refugees and asylum seekers, have managed to use the system of parliamentary democracy by talking to hon. Members individually as constituency MPs to have the affairs of their communities in Pakistan and Afghanistan, many of which have personal links—personal sufferings connect them—raised in the House. That is a significant achievement.
	Secondly, beneath the points of principle on action raised in the debate, policies that could be changed and reports that could be made, there is a great deal of detail that we would like to discuss with the Government about how they could develop relationships with Afghanistan and Pakistan, and develop the aid programme. I look forward to the opportunity of doing so.
	Thirdly, our country has been tied up with the histories of both Afghanistan and Pakistan for many years, including recent years. People, including many of our constituents, are tired of our involvement. I hope that, tonight, we have made the simple point that we cannot walk away. We have responsibilities for the position faced by the Hazara community and others in Afghanistan and Pakistan, and we must ensure that we do not allow them to slip.
	Question put and agreed to.
	Resolved,
	That this House has considered the position of Hazaras in Afghanistan and Pakistan.

CLINICAL TECHNOLOGY APPRAISALS (NICE)

Motion made, and Question proposed, That this House do now adjourn.—(Dr Thérèse Coffey.)

Eric Ollerenshaw: I welcome the Minister to his place. I hope that he does not feel that he has drawn the short straw by having the 10 o’clock slot. I am pleased to be here to have the opportunity to raise an issue of growing concern to NHS patients throughout the country, particularly those suffering from cancer. It will be a debate about how new drugs and treatments are approved, or not, by the National Institute for Health and Care Excellence. That organisation’s acronym spells NICE, but, sadly, for many patients the decisions it makes often seem anything but.
	Tonight’s debate is particularly timely given the announcement last week about the expansion of the cancer drugs fund. That is of course welcome, but it does serve to highlight the ongoing problem. That announcement comes on the back of a number of recent decisions by NICE not to fund important new cancer drugs. Both Kadcyla for metastatic breast cancer and Abiraterone for routine use in prostate cancer are high- profile examples, so the whole issue of the affordability of the drugs bill is back in the news, and especially how NICE carries out its cost-benefit analysis and comes to its decisions.
	My original reason for raising this issue was the current review of NICE’s technical appraisals, the consultation on which closed earlier in the summer. I will make some specific points on that, but first I want to set out the problem as I see it and give some wider context. Put simply, I do not believe that the appraisal system is fit for purpose, at least not for cancer drugs. In 2011-12, NICE rejected 60% of the cancer medicines that it assessed. What makes it worse is that the rate at which they have been turned down has actually increased since 2010. That is largely because the methods used to work out the cost-benefits of each drug are too restrictive. The use of what are called “quality of adjusted life years” does not take into account many potential benefits for patients and their families. The appraisal process is also far too long—it can take a year to conclude that a new drug priced by a company at X is not cost-effective. Subsequent resubmissions by a company, based on a new price or new clinical data, can then take just as long.
	Most of these drugs are already licensed for use in the UK but can be obtained only through private health care. It was that repeated failure to give patients on the NHS the same access to cancer drugs that led to the creation of the cancer drugs fund. That was a hugely welcome move, and I commend the Government for it. Because of the fund, 55,000 patients have since 2010 been able to access drugs that they would not otherwise have had. But we have to admit that the CDF is, in a sense, a sticking plaster. It was only ever envisaged as an interim measure until NICE got its act together and became more user-friendly. Even with the welcome new boost to its total funds, the CDF is scheduled to expire in 2016. That expiry date is fast approaching and many, particularly amongst the charities, are worried about what will happen after that date.
	There is another level of uncertainty. Drugs on the CDF can be de-listed at any time. The failure of NICE to approve treatments means that the fund has been working at or above its planned financial capacity. Again, I am grateful that the Government have recognised that with the announcement last week, but the chair of the fund seemed to hint last week that time may be called on some of the drugs on the list very soon. That would be a disaster for possibly thousands of patients and their families around the country. I understand that these things need to be considered in detail, but I would be very grateful if the Minister could address this specific issue in his response. In particular, will he clarify the process and likely time scale for any de-listing of drugs?
	What does this mean in practice? The Minister knows that I have a particular concern for improved treatments for pancreatic cancer patients. He may remember an Adjournment debate back in March when we discussed the new drug Abraxane. When used in combination with standard chemotherapy, it has been shown in trials to extend eligible patients’ lives by an average of just over two months, although in some cases it is significantly more.
	At the time of the debate in March, I expressed my support for Pancreatic Cancer UK’s “Two More Months” campaign, which gave a number of examples of what two more months in life would have achieved for various people, and asked Ministers for the drug to be added to the CDF. Imagine my delight when that happened. As I understand it, between the end of March and the end of June this year, 118 patients have accessed Abraxane on the NHS. That would not be happening if CDF did not exist.
	Abraxane is currently under consideration by NICE for routine use for eligible metastatic pancreatic cancer patients on the NHS—a move that would make it easier for patients to access the drug. I believe that a decision on whether to approve Abraxane for use will be made in the next few weeks. However, if we use the quality-adjusted life-year system, the price of an additional two months of life looks set to be deemed too costly. Most drugs are capped at £30,000 a year, and Abraxane is estimated at slightly above £50,000.
	Although NICE allows a higher cost threshold of about £50,000, that is only for drugs that meet its current end-of-life criteria, which demand that a new drug provide at least three months’ extra survival on average. The evidence so far does not show that Abraxane does that. However, if we consider that the average survival time for a pancreatic cancer patient from diagnosis is just two to six months, we can imagine that an extra two months’ survival is massively significant. Instead of having arbitrary targets in terms of months, why do we not look at percentages of the average survival rate as a means of dealing with these more difficult cancers and diagnoses?
	If Abraxane is rejected by NICE, as I fear it might be, we will be back to relying on the cancer drugs fund to provide it. It will end up like other treatments that are available for pancreatic cancers, only one of which has been approved by NICE. Non-drug alternatives such as NanoKnife and CyberKnife, which have been discussed in this Chamber, are in use in private practice but have not been approved by NICE for clinical use on the NHS. Patients are forced to spend tens of thousands of pounds of their savings to access those treatments privately.
	We are in a position where new treatments might start to make a small difference in survival rates for pancreatic cancer—there have been no improvements in those rates over the past 40 years—but such improvements will have been despite, not because of, NICE. That must change.
	Indeed, change is now in prospect. NICE is currently looking at introducing a new way of assessing drugs, called value-based assessment. The consultation on it closed in June and I understand that some next steps are due to be announced very soon.
	I have looked at the proposals, but I must say to the Minister that there are worries that the new system will not improve the current situation. Briefly, my concerns are these. First, the proposals maintain a quality-adjusted life-years system as the basis of an appraisal. That will still mean that many benefits to patients and their loved ones highlighted by patient groups might not be taken into account. Secondly, it is proposed that specific end-of-life criteria be removed and incorporated in a wider “burden of illness” measure. There is no guarantee that this measure will capture the unique requirements of end-of-life drugs. Thirdly, the way the proposals are framed could well mean that the age of patients with a particular condition could count against the drugs, which is a particular concern given, as everybody knows, that the likelihood of getting cancer increases with age. Perhaps more importantly, I see nothing in the proposals that suggests that the new appraisal process will be any quicker than the current one, and time is one thing that many cancer patients do not have.
	I have serious reservations about the proposals. The crucial question is this: will the new system make more cancer treatments available or fewer? If there were confidence that the new set of criteria would solve the problem, we might not be facing the need for extra funds, but as things stand, the extra CDF money remains the lifeline. If the new system does not solve the problem and the CDF ends in 2016, we will be back to square one, with thousands of patients not getting the drugs they need and deserve—drugs which over the past four years have been proved to make an immense difference to patients’ and their families’ and friends’ lives.
	These fears are shared by many cancer charities and patients groups. I hope that their responses to the consultation will be given the consideration they deserve. If they are, it should be possible to devise a system that genuinely works. That means a system that works faster. The NICE process is extensive, but it takes too long. Why on earth when a drug is rejected at one price does the whole elongated process that I have mentioned have to start again when it is resubmitted at a new price? There is an argument that that simply encourages companies to pitch a high price to begin with, and therefore creates further delays as the argument goes on to get the price down. Why can we not have a system where there are sensible negotiations between NICE and the drug companies immediately after a drug is licensed, along the lines of systems used in many continental countries?
	The system should also give more weight to patients’ and carers’ needs and experiences. At the moment, the process is almost exclusively focused around clinical effectiveness—that is understandable—and value for money. Patient engagement is ostensibly taken into account, but it needs to be given a higher priority. The
	Scottish Medicines Consortium has just changed its system along those lines, and that might be a good model to consider.
	Lastly, a specific end-of-life weighting really must be maintained in the new system. It cannot, however, be so prescriptive that it excludes new treatments for cancers with extremely poor prognoses, such as pancreatic cancer. NICE’s current three-month rule makes that a specific problem that the new system must tackle.
	To sum up, of course the NHS does not have an unlimited budget—we all understand that—and it is right to seek value for money for taxpayers. Drug companies must also be realistic when pricing their drugs, but as I have said, the current system provides incentives for them to pitch high. This review of appraisals gives us an opportunity to make them work better. We urgently need reform because for too many cancer sufferers NICE simply is not working.
	Until that improved system is in place, the cancer drugs fund will remain vital, and the extra money will be well spent. I hope that it will be extended beyond 2016 to make sure there is at least one fast and effective route for cancer drug approvals. However, that can only ever be a temporary fix. There must be a more reliable long-term system to get cancer patients the treatments that they so desperately need. Such decisions can literally be life-and-death ones, and too often we are not getting them right. Cancer need not be a death sentence, but the rejection of a drug based on a flawed assessment might be one.
	For many patients, extra days and months are not just numbers in a cost-benefit equation, but precious moments with loved ones. NICE must recognise that the timeline is arbitrary, and it must start to build on the success of the cancer drugs fund.

George Freeman: May I say what a pleasure it is to start my role on the Front Bench under your careful guidance tonight, Mr Speaker?
	I pay tribute to my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) for his tireless campaigning on this subject, his leadership in the House and his work on the all-party group on pancreatic cancer. He has been a tireless campaigner on behalf of patients affected by pancreatic cancer, which is a terrible disease. I know that the subject is very close to his heart, having been affected by the tragic loss of his partner from pancreatic cancer. I applaud him and pay tribute to him for the work he has done. I pay tribute to all the patients and charities who are so active in this area, and I assure him and all those affected that we want to see the best possible outcomes for all NHS patients and loved ones, including those with pancreatic cancer. As is so often the case, the impassioned advocacy of patients and their loved ones forces the system to address the priorities of the patients whom we are all here to serve.
	It is vital for people, especially those affected by long-term and life-threatening conditions, to have access to new and promising treatments. That is one of my key priorities in my new role. I well understand how disappointing it is for patients and carers when NICE does not recommend a particular drug or treatment for which they have held out such hope. A central part of
	my mission as the UK’s first Minister for life sciences—an opportunity that reflects the Government’s commitment and the Prime Minister’s personal commitment to this agenda—is to accelerate the discovery, design and adoption of new drugs in the NHS, making the UK the best place in the world to discover and design 21st-century health care technologies.
	My hon. Friend raised a number of important points that I want to address. In particular, he asked whether the appraisal process of the National Institute for Health and Care Excellence is fit for purpose and spoke about the time that is taken over the approval of new drugs and the importance of the cancer drugs fund. He made a number of specific references to treatments, not least to Abraxane. I will reflect on those references and write to him so that I have time to address his substantive points.
	I will start by taking a step back to reflect on the context in which NICE works, including the pressures and opportunities that the extraordinary pace of biomedical discovery is unlocking. In an age when so many new drugs and treatments are being discovered because of the extraordinary success of our scientists and our life sciences industry in bringing innovation to the market, and in a world in which more people are living longer and in which our resources are under ever more sustained pressure, it is no surprise that we hear with increasing frequency stories of new drugs and of NICE’s decisions to restrict their use to smaller groups of patients.
	As my hon. Friend is all too aware, we, like other Governments across the globe, face a great challenge to ensure that every pound of health service money is well spent on effective treatments. The NHS does not have an infinite budget. As we make significant advances in these areas, which in turn will bring more treatment options, the demands on those resources will increase. The discovery of new treatment options is great news, but it brings new challenges. That is particularly relevant to cancer, for which a number of new high-cost drugs have arrived in recent years. Some of those, despite their cost, offer only marginal improvements in quality and length of life. I recognise, as my hon. Friend pointed out, that for patients who are dying, a few extra months provide precious extra time for them and their loved ones. The challenges is to find an equitable way of dealing with the difficult ethical, medical and economic judgments that we have to make. That is where NICE fits in.
	Over the years, this country has, through NICE, led the way in developing an evidence-based assessment system to determine how drugs and treatments are best used in the NHS. Initially set up in 1999, NICE has played an invaluable role in providing internationally respected guidance to the NHS on the clinical and cost effectiveness of drugs and treatments. Those are difficult decisions to make. NICE reaches its final decision on the use of a particular technology only after careful and thorough consideration of all the available evidence and following extensive consultation with stakeholders.
	The Government firmly believe that cost-effective, clinically appropriate drugs and devices should be routinely available to NHS patients. That is why NHS commissioners are legally required to fund treatments that are recommended by NICE’s appraisals, why the right of patients to NICE-recommended drugs and treatments is enshrined in the new NHS constitution, and why we are acting to promote the rapid uptake of NICE-recommended drugs in the NHS. Many thousands of
	people in England have, as a result, benefited from the treatments that are recommended by NICE, including for cancer. I am pleased to note that so far this year, NICE has recommended five new cancer drugs on the basis that they are clinically effective and cost effective.
	However, the rapid development of breakthroughs in genomics, informatics and new diagnostics means that NICE’s processes will have to adapt. Since it was established in 1999, NICE’s internationally renowned technology appraisal process has evolved constantly to meet new challenges. I am confident that it will continue to do so—it will need to if it is to keep its place at the vanguard of international health technology assessment.
	The UK and NICE led the world in the late 20th century in pioneering the health economics of drug discovery. However, the breakthroughs in genomics and clinical informatics are transforming the way in which drugs are discovered and are allowing us increasingly to design drugs around patients and their tissues, data and genomic and phenotypic history. That is unlocking a new era of targeted and, ultimately, personalised medicine. Drugs may be designed for patients in whom we know they will work. That will allow us to change the way in which we procure and provide reimbursement for drugs—from payment on performance to outcome-based payments.
	We are at the dawn of an exciting new age of more accurate, effective, specific and targeted medicines. We no longer expect to give every drug to every patient. We do not expect the industry to bring drugs to us that can be proven to work in every single patient. We will be able to unlock huge efficiencies in the NHS’s £12 billion drugs budget through a much more targeted model of medicine, and it will mean a radically different mission for NICE in the coming years. Accelerating this country’s leadership in that area is central to my appointment, and I am delighted to be able to take the opportunity to spell that out.
	I note my hon. Friend’s concerns about the length of time that it can take for new drugs to be made available. I very much recognise that as both a core barrier to making the UK the best place in the world to develop new medicines and a great opportunity. I should like to speak a little about a particular case that illustrates the importance of early access.
	I recently met, and got to know, a leukaemia and lymphoma patient who was diagnosed 10 years ago with chronic myeloid leukaemia. He was in his early 40s and had a young family, and he was given about three years to live—10 years ago. He is alive today because he was one of just three patients placed on a clinical trial by his oncologist at the university of Birmingham hospital back in 2001. The trial, of Glivec, now one of the most commonly used CML drugs, was his lucky break. He was one of the first patients to receive a groundbreaking new treatment, giving him an extra decade with his young family and now a clean bill of health and a life that he is using as a pioneering campaigner for the revolution of targeted medicine.
	Of course, it is important that any new medicine is shown to be effective and safe before it is used routinely within the NHS, but I believe that we need to do much more to help the patients in the direst need to access pioneering drugs more quickly so that luck does not come in to it. That is why the Prime Minister and I have committed to the early access to medicine scheme, which we launched earlier this year. That UK-only scheme addresses unmet need on an unlicensed or off-label
	basis for patients with life-threatening or seriously debilitating conditions who do not have adequate alternative treatments, by supporting access to very promising new treatments long before we would normally expect to receive them through the usual approval process. We have much more work to do, but I am pleased to see that the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency, is now starting to receive applications for the scheme. I am also pleased to say that pioneering life science companies have pledged their support and made applications to the European Medicines Agency’s adaptive licensing pilot. NICE has also been involved in discussions on both those initiatives, along with NHS England, to ensure that licensing decisions translate into patient access. The central aim of the early access to medicines scheme is to create a new fast-track runway to get a new generation of innovative medicines to the patients for whom there is no alternative treatment, to give them a chance and some hope that their suffering might help to prevent suffering for future generations.
	My hon. Friend also raised the important issue of the length of the NICE appraisal process. I appreciate how important it is, when new drugs are licensed, that the NHS has good guidance on their use as quickly as possible so that clinicians can make the best possible use of them. In drug discovery, time is money, and accelerating assessment and approval is the single most important reform that we have to make. I am absolutely committed to it. In fact, I met NICE’s chief executive and chair today to highlight that point. For me, tonight’s debate marks the beginning of a conversation about the new model for NICE and our work with it on that model. NICE is an independent organisation, and it is not for me to second-guess what its final proposals will look like, but we have made it clear in the terms of reference that the end of life will continue to be given important consideration. There will certainly be no unlawful discrimination.
	I mentioned genomics. Genomic technologies are allowing us to make groundbreaking discoveries about how disease works, how different patients become susceptible to different diseases and how we can diagnose disease earlier, treat it and ultimately prevent it. That is why the Prime Minister and I recently announced a £300 million investment to make the UK the world leader in genomic medicine. For the first time in the world, 100,000 full human genomes from volunteers will be sequenced by 2017. It is the most ambitious project in biomedicine in the world, and it is a world first. The development of genomically informed medicine will lead to faster diagnosis, with knowledge based on genomic technologies being used to better target treatments and get the right patients the right treatment faster than is possible today. I do not think it is an exaggeration to say that it has the potential to transform how we evaluate medicines, the benefits they deliver, who they deliver them to and how effectively. It will help bring to an end the averaging of outcomes, which sits at the heart of the current NICE model, allowing us to work out how to give the right drugs to the right patients much quicker than is currently possible.
	My hon. Friend mentioned the cancer drugs fund and the benefits that it has brought to many patients and their loved ones. More than 55,000 patients have
	benefited from the fund since October 2010, and I am delighted to be able to confirm that the Prime Minister, the Secretary of State for Health and I are all committed to the renewal of the fund. Indeed, we announced last week that an additional £160 million would be made available to the fund through to March 2016, which will allow patients to continue to receive the extra drugs that are right for them.
	We also announced plans for NHS England, NICE, charities and industry to work together to improve the way cancer drugs are commissioned. We must make better use of the cancer drugs fund to generate better data on new drugs, so that we can address the uncertainties that so often affect early clinical trial evidence, and help NHS patients and clinicians to understand the real world value of those drugs—indeed, today I met Harpal Kumar from Cancer Research UK to discuss that point. I note my hon. Friend’s concerns about future access to cancer drugs, and will carefully consider with NHS England what arrangements should be put in place for the fund in the longer term.
	Central to this quiet revolution is patient empowerment, and 21st-century health care will move from being something in the 20th century that was done to patients by the Government when they deemed it appropriate, to something that 21st-century citizens will be entitled to and empowered to take more responsibility for themselves. In access to research and drugs, access to outcomes data, and people’s ability to shape their health choices, we are committed to accelerating that quiet revolution.
	Ensuring patients have more say in how their care is delivered and embedding choice are key themes in the Health and Social Care Act 2012, and I intend to accelerate that in the field of health care technology. This quiet revolution is what the Government’s life science strategy set out to frame and accelerate. That is why we have created a new Office for Life Sciences, bringing together officials from the Department of Health, the Treasury, and the Department for Business, Innovation and Skills. There is a new directorate in the Department of Health to accelerate innovation, and a new ministerial post, which it is my honour to hold. A package of other measures will help to make the UK in the 21st century once again what we were in the early 20th century—the world leader in medicines discovery.
	Twenty-first century health care is being utterly transformed by breakthroughs in genetics, informatics, diagnostics and the new field of targeted medicine. It will transform the way we design and procure new medicines, and the way that NICE assesses their costs and benefits. I intend to ensure that this country seizes the opportunity for the benefits of our children, so that Britain is once again the best place in the world to discover new medicines and to be treated by them.
	I congratulate my hon. Friend again on his advocacy and the important issues he has raised tonight, and I will write to address his specific points in detail. I look forward to working with him and the many other groups in Parliament and outside who are increasingly active in that space, to ensure that his partner, and many hundreds of thousands of others like him, have not died in vain.
	Question put and agreed to.
	House adjourned.